Healthy Ageing Research Group, University of Manchester – Written evidence (INQ0072)

Executive summary

• There is robust evidence that adoption of healthy lifestyle behaviours mitigates many long term conditions even when positive changes are adopted in later life. For activity some is good, more is better. (UK CMOs’ Guidelines 2019)
• The challenge lies in finding innovative, engaging ways to assist the increasingly large population of older adults to stay active, healthy, happy and independent.
• There is a gap between evidence and its implementation. Major gains are to be found in ensuring the evidence that already exists is implemented into policy and practice. There is emerging evidence that technologies can be used to assist implementation and promote healthy active lifestyles.
• We highlight three technological innovations to promote healthy ageing, a Smartphone app for activity promotion, exergaming for fall prevention, and a tablet based app for strength and balance training. 
• Technological solutions should implement evidence-based interventions, be co-designed with older adults, and involve underlying theoretical principles of behaviour change. Their effectiveness must be robustly scientifically evaluated if they are to be used to promote healthy, active ageing.
• There is a dearth of such products on the market, which provides opportunity for UK commercialisation; but also offers opportunity for evidence-based innovation throughout UK health and social care services.
• Promoting healthy lifestyles over the life-course and supporting the detection and modification of mid-life risk factors such as being inactive and sedentary will play a major part in preventing impaired function and morbidity in older age.
• Healthier older people will continue to be engaged fully in society.  Successful ageing could be a major benefit for the UK, not the negativity framed burden ageing is all too often portrayed to be.

The scientific understanding of the ageing process, and how these areas of research could lead to treatments for delaying or managing the negative effects of ageing (Scientific basis)

• There is robust evidence that healthy lifestyle behaviours such as regular physical activity, eating a high quality, unprocessed diet, avoiding excessive alcohol, avoiding smoking and other substance abuse mitigates many long term conditions (diabetes, heart disease, respiratory disease), even when positive changes are adopted in later life. For activity some is good, more is better. (see UK CMOs’ Guidelines 2019)

• The challenge lies in finding innovative, engaging ways to assist the increasingly large population of older adults to stay active, healthy, happy and independent.
• Engaging in physical activity, to include muscle strengthening, bone health and balance activities at least twice per week from mid-life can reduce falls risk and improve health outcomes.  Whilst the evidence is strong for strength and balance interventions, there is an implementation gap across England (see; Raising the bar on strength and balance, 2019)
• Nutrition is important, as is identifying and preventing malnutrition to ensure older adults have a healthy diet, this should include access to fresh produce, enough money to buy nutritious food and equal access to online shopping.
• Health literacy on nutrition and eating for health in advancing years and avoidance of multiple dietary restrictions for chronic conditions is key (as oppose to confusing/conflicting messages)
• Physical activity has been shown to increase wellbeing and can help older adults to maintain social connectivity and avoid loneliness. Evidence suggests using a holistic approach of combining methods to increase physical activity and optimise nutrition through education and using health behaviour change theory.
• Messages should be “gain framed”, that is they should emphasise the positive effects of being more active (e.g. feeling and looking better, maintaining independence) rather than focusing on risk to be avoided (e.g. falls or injuries) (see e.g. Yardley et al 2006)
• Major gains are to be found in ensuring the evidence that already exists on the benefits of specific exercises, activity promotion and avoidance of being sedentary are implemented. There is emerging evidence that technologies can be used to assist implementation and promote healthy active lifestyles.
• There is a risk that technologies can exacerbate the health inequalities of ageing unless this issue is carefully taken into consideration in their design and roll out. Specifically, poorer and more deprived older people are less likely to have access to expensive technologies, including Smartphones and tablets, which may be required to access services, or to promote health.

Technologies that can improve health and wellbeing in old age, and technologies that can enable independent living in old age (Technologies)

• We have successfully demonstrated the use of interactive eHealth/mHealth applications underpinned by behaviour change theory and providing evidence based interventions. (Boulton et al 2019). Such evidence based apps could provide opportunity for scaling up of population health interventions promoting healthy ageing, but need to be appropriate for the population being targeted.
• In a randomised controlled trial we have demonstrated the benefits of exergaming for older people (Stanmore et al 2019). This exergame is a tele-rehabilitation system that has gamified evidence based physiotherapy exercises. Falls were significantly reduced and balance, pain and fear of falling significantly improved.  In addition older people enjoyed participating in the exercise sessions and showed higher than expected adherence to the programme. This technology is now in use in rehabilitation wards and community rehabilitation teams in Greater Manchester, and used by NHS England as part of the NHS at 70 campaign (see here).
• We have also developed smartphone and tablet-based technologies for older adults to assist them with maintaining optimum levels of exercise, nutrition, hydration and bone health for example Keep on Keep up (see here).

Opportunities for the UK to commercialise discoveries and innovations relating to healthier ageing (Industrial strategy)

• Older adults want to remain independent in their communities and remain as active as possible they age. Interventions and technologies that support these objectives from smart homes, through smart watches and apps on hand held devices, to assistive robotics, are important and have a growing market among older adults.
• Technology based apps (mobile, tablet and/or web based), when evidence-based interventions (such as the FaME strength and balance programme (Skelton et al 2005)) are at their core, when designed with older adults, when involving psychological theory to promote behaviour change, and properly evaluated, have great potential to augment service provision, and promote healthy, active ageing. Currently such products are not on the market.
• Exergaming approaches such as the one we developed and tested (Stanmore et al 2019) are currently being commercialised by MIRA Rehab Ltd. Such innovations from working with universities present important commercial opportunities for UK based SMEs.
• Artificial intelligence and machine learning are increasing the ability to predict health risk factors and personalise interventions.  Such approaches will provide commercial opportunities across the field.  For example we would foresee a version of our activity promotion app which could learn to create maximally effective personalised health promotion messages based on individuals’ behaviour (and psychological theory).
• Such evidence-based innovations could provide cost-effective solutions to challenges facing the NHS, and public health across UK health and social care services.

The policy implications of a healthier older population (Healthier ageing)

The core issues for ageing policy revolve around the increasing numbers of people living into increasingly older age.  From a policy perspective a central concern should be to ensure the compression of morbidity and the maintenance of active, engaged, high quality healthy lived years.

• To achieve this we need to promote healthy lifestyles over the life-course and support the detection and modification of mid-life risk factors (such as: sedentary behaviour and inactivity; smoking; etc.) to prevent later prematurely impaired function and long-term disease.
• Compression of morbidity implies that older people could play fully contributory and fulfilling roles in society for longer, ensuring expertise gained over many years of experience is not lost.
• From an economic as well as a quality-of-life perspective, supporting older adults to remain at home and to age “in place” can provide numerous advantages.
• Large numbers of older people provide unpaid caregiving for their loved ones and friends, older people play an important role in many voluntary and charitable services. Supporting older carers should be an important policy priority.
• Policies should ensure that social and health inequalities are not exacerbated by ageing, nor by the technological innovations related to ageing. All too often ageing is portrayed in terms of burden on society rather than recognising the benefits that may be accrued from successful ageing. Whilst recognising that the ageing of our population provides challenges for UK, such negative stereotyping should be combatted, and the opportunities of fulfilling, longer, healthy lives embraced.

The Authors

The Healthy Ageing Research Group (HARG) at the University of Manchester is a multi-disciplinary group conducting research aimed at promoting healthy and active ageing. Our work covers the range of ages considered for older people (including younger older people e.g. 55+/retirement age, and the oldest old).

HARG’s high quality population health research uses quantitative, qualitative and evidence synthesis review techniques and has an emphasis on healthy and active ageing so to promote active participation in society.  We develop research capacity in the topic, ensure our work has direct relevance to policy and practice for older adults at a local, national and international level.  We engage with and involve the public, patients and stakeholders in our research activities.

Areas of expertise include: falls and falls prevention, activity and exercise promotion (strength and balance), nutrition and diet, development and evaluation of novel mHealth and eHealth technologies, clinical decision making support tools, health behaviour change and health literacy, musculoskeletal conditions, mixed-methods research methodology, critical appraisal and evidence synthesis, and user-involvement in design of technologies to support healthy ageing.

20 September 2019

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