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

1. Healthy Ageing in a
disadvantaged neighborhood
Annemiek Bielderman
Research and Innovation Group in
Health Care and Nursing
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2. Contents
• Ageing and Healthy Ageing
• Healthy Ageing and Lifestyle
• Ageing in disadvantaged neighborhoods
• Delfgoud project
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3. Ageing of the population
Percentage younger (0-14 years) and older people (65+ years) in
various European countries, 1850-2050.
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(Netherlands Interdisciplinary Demographic
Institute)

4. The number of
Ontwikkeling
The ageing in the adults (>65)
related to adults
Netherlands
grijze druk (20-64)
2010-2025
2010-2025

5. Healthy Ageing
Stephen Hawking
69 years old
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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-dimensional
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7. A healthy lifestyle is a prerequisite
for healthy ageing
Loss in healthy
Loss in years
years (HALE)
Smoking
Overweight
Obesitas
Excessive alcohol use
Physical inactivity
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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 health
C = time lost due to premature mortality
Life expectancy = A + B
Health expectancy indicators (e.g. healthy life expectancy and HALE) = A + f(B)
Health gaps indicators (e.g. DALYs) = C + g(B)

9. Effect healthy lifestyle on
HALE

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. 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)

13. Studies suggest elderly who have positive perceptions
of ageing slow down frailty in late life

14. Disadvantaged neighborhoods
• Socio economic status (SES):
– Based on income, education, and occupation
(Winkleby et al., 1992)
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15. Disadvantaged neighborhoods
• SES is a strong predictor of physical and
mental health status
Socioeconomic health differences
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16. 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 factors
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17. Socioeconomic health differences
1. 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)

18. Socioeconomic health differences
1. 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)
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19. Socioeconomic health differences
1. Life expectancy lower in low SES persons
2. 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)

20. 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)
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21. Ageing and low SES
• Diminish the health differences between low
and high SES elderly people
Improve the health of elderly people
with a low SES
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22. Delfzijl
Amsterdam
Groningen
Utrecht
Assen
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23. Regional differences in Social Economic Status
in the Netherlands
Geografische verschillen in gezondheid. VTV-2006, Bilthoven: RIVM.
23 www.rivm.nl

24. 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 inactivity
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25. Improve the health of elderly
with a low SES
How 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
group
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26. 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.
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27. 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?
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28. 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 coping
Resilience theory with (pre) frailty
Enhancement of sense of
Salutogenesis paradigm Enhancement of coherence is a prerequisite for
healthy ageing
healthy ageing
Reserve Capacity Model
Coping with age related stress
due to chronic diseases, anxiety,
depression and loneliness
Decrease in disability
and increase in
quality of life
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29. DELFGOUD project
• DELFGOUD: multi-factorial intervention
program
• The interventions:
– Physical activity
– Social skills training
– Depression intervention
– Healthy eating intervention program
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30. 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 pattern
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31. 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 / Depression
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32. 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, loneliness
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33. Measurements
• Outcome measures:
– Quality of life
– Physical fitness
– Loneliness
– Social contacts
– Depression and anxiety
– Eating pattern
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34. 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 loneliness
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35. 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 a
Annemiek Bielderman healthy lifestyle in deprived older
j.h.bielderman@pl.hanze.nl
adults.
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36. Partners
Netwerk Ouderenzorg Regio Noord
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