Optimising health in an ageing population. Good for the person, good for the system

by Chris Hall

“It’s not how old you are; it’s how you are old.”?

Jules Renard.?

The Silver Tsunami: [1-5]

One of the undeniable global achievements in the 20th Century was the rise in global life expectancy. For example, since the founding of the World Health Organization in 1948, life expectancy globally has increased from 46 to 73 years (often referred to as the silver (or grey) tsunami). While this is cause for celebration, it provides a significant challenge in ensuring people live longer in good health.

As we look to the coming decades, the increases in multimorbidity (the presence of two or more chronic conditions simultaneously in one individual) are stark. While multimorbidity is not a problem only for older adults, its prevalence is much higher in older age groups. For example, in Scotland, 65% of people aged 65–84 years and 82% of people aged at least 85 years were affected by multimorbidity in recent years. By 2050, it is thought that nearly 15 million Americans over 50 will suffer from multimorbidity.

It is tempting for society to see ageing, in and of itself, as a disease and those getting older as becoming disease-ridden. However, we must forcefully push back against this.

We know ageing is likely responsive to changes or adaptations at an individual level to improve functional health. Low-cost interventions such as resistance training can be powerful interventions. Resistance training in older adults not only combats the loss of muscle strength and mass but improves physical functioning, mobility, independence, chronic disease management, psychological well-being, quality of life, and healthy life expectancy.

As we age, some changes occur in all organs; most changes can be primarily managed effectively. And while changes such as these and, ultimately, death are inevitable, disabling chronic illnesses are not.

Managing multimorbidity: [6-11]

Given the scale of the problem, it is no surprise that international action is underway. In its first review of good practices across Europe in 2013, the EU’s Action Group on Prescription and Adherence to Medical Plans identified a significant issue with polypharmacy and poor medication adherence amongst patients with multimorbidity, highlighting the increased risk of adverse events and hospitalisation associated with inappropriate prescribing.

Recent research has demonstrated improvements in multimorbidity management through both a system-level and a patient-centred approach. From our perspective and where we can have the most influence, the patient-centred approach is the most interesting and can be thought of in the following way:

1. Improving health and digital literacy
2. Building the healthcare professional-patient relationship
3. Promoting shared decision-making and setting realistic goals
4. Supporting self-management (for example, through ‘wearables’ tracking and real-world evidence generation)

These components comprise patient activation, which describes an individual’s willingness and ability to take independent actions to manage their health and care.

Several unmet needs for patient-centred care have been raised, which, for brevity, can be broadly grouped into the following categories:

1. Lack of a holistic approach by different healthcare professionals (insufficient attention to the patient’s state of functioning, their limitations in daily life, and their well-being)
2. Lack of personal continuity of care
3. Lack of patient-tailored explanations about diseases and treatments
4. Lack of social and mental health support

Additionally, these unmet needs are likely to be greater in ethnic minority groups and those from lower socioeconomic backgrounds.

The role of industry: [1,12-17]

This is most important for those in industry with Global or International remits. Not only is multimorbidity very common in wealthier nations, but around 80% of the world’s older population will live in low and middle-income countries by 2050. This must be considered carefully, given the dramatic impacts this could have, such as 71% of people with dementia living in these countries. However, given rapid technological advances, ageing does not have to be associated with worrying statistics. Happy, healthy ageing, where people contribute positively to society in a range of ways, can be a reality for most people, and while technology will undoubtedly be at the heart of it, the basics must be tackled first.

Industry can improve this situation straightforwardly based on the current unmet needs for multimorbid, older patients. The following initiatives can be focused on quickly and need not be cost—or resource-intensive.

Working directly with older, multimorbid patients:

• As patient involvement has become more sophisticated and more impactful, there remains a dearth of experience with older people. This is likely because of the apparent complexity of involving older adults and the belief that they may not be able to contribute as much as younger people.

‘Joined-up’ education:

• Given the polypharmacy of multimorbid patients, a truly patient-centred approach to care is crucial. Cross-disease, above-brand disease awareness could help older patients with treatment adherence, coping skills and quality of life.

Integrated physical and mental health care:

• The effect on self-reported health of mental health symptoms caused by physical illness is an increasing public health problem. As medicine advances and life expectancy increases, there are growing expectations to live a healthy life even in old age. Industry can provide specific integrated physical and mental health management education to older patients, helping them optimise their care beyond treatment.

How we work with these people must be addressed in everything we do. Older, multimorbid populations are more likely to be isolated and lonely and, therefore, hardest to reach. Alongside industry, a multi-stakeholder approach is needed to fully engage with this audience (social care, NHS, charities, community groups, etc). Additionally, we must consider the process in which we engage. Adjusting for digital capabilities, mobility for meetings, accessibility of contracts and so on. We must ensure SOPs and compliance can flex to this.

Where do we go from here?

Fundamentally, greater political will and increased resources are necessary to create a world where all people live long and healthy lives. However, the question remains within industry: what can we do to ensure healthier ageing?

There are clear gaps for industry to lend its expertise to provide significant value to multimorbid patients. This will not only improve adherence and reduce adverse events but also improve multimorbid patient management, which could substantially ease the stress on health systems as the predicted numbers increase over the coming years.

We must work together, working directly with older people, their families, and communities. Additionally, a more joined-up approach to disease education across relevant therapy areas, such as cardiovascular or respiratory, focused on the impact of healthy ageing with multiple diseases, could greatly benefit multimorbid patients. As creators of innovation, the responsibility falls upon industry to partner up and rise to this occasion. The imperative is clear: we must be the architects of a new dawn where everyone, regardless of age or ailment, finds health and happiness in a world that nurtures their well-being.

At Aurora, over our 18 years, we have focused on working closely with distinct groups of people when creating patient and healthcare professional education. We have significant expertise and case studies in this area. Our team of experts in patient advocacy, behavioural science and communications recognise the importance of proactive chronic illness management for the benefit of the individual patient, healthcare system and society. We have launched our All for Activation behaviour change approach to create effective, measurable interventions that aim to positively impact all stakeholders to achieve success with patient activation strategies. Get in touch if you’d like to hear more - [email protected]

References:

[1] . WHO. Progress report on the United Nations Decade of Healthy Ageing, 2021-2023. Accessed January 2024.

[2] . Banerjee S. Multimorbidity—older adults need health care that can count past one. The Lancet. 2015:14;385(9968):587-9.

[3] . Fulop T, et al., Are We Ill Because We Age? Front Physiol. 2019;18(10):1508.

[4] . Fragala, Maren S. et al., Resistance Training for Older Adults: Position Statement From the National Strength and Conditioning Association. Journal of Strength and Conditioning Research 2019;33(8):2019-2052.

[5] . Jaul E and Barron J. Age-Related Diseases and Clinical and Public Health Implications for the 85?Years Old and Over Population. Front Public Health. 2017;11(5):335.

[6] . European Commission. Replicating and tutoring integrated care for chronic diseases, including remote monitoring at regional level 2013; Brussels: European Commission. https://ec.europa.eu/research/innovation-union/pdf/active-healthy-ageing/gp_b3.pdf#view=fit&pagemode . Accessed January 2024.

[7] . Rohwer, A. et al., Models of integrated care for multi-morbidity assessed in systematic reviews: a scoping review. BMC Health Serv Res 2023;23:894.

[8] . Health Affairs. What the evidence shows about patient activation. Available at: https://www.healthaffairs.org/doi/10.1377/hlthaff.2012.1061 . Accessed: January 2024.

[9] . Jingjie Wu, et al., Healthcare for Older Adults with Multimorbidity: A Scoping Review of Reviews, Clinical Interventions in Aging, 2023;18:1723-1735.

[10] . Wagner C, et al., How life course socioeconomic conditions shape multimorbidity in old age – a scoping review, European Journal of Public Health, 2022;32(3).

[11] . Rolewicz L, et al., Are the needs of people with multiple long-term conditions being met? Evidence from the 2018 General Practice Patient Survey. BMJ Open 2020;10:e041569.

[12] . Alzheimer’s Disease International. Policy Brief for Heads of Government. The Global Impact of Dementia 2013–2050. https://www.alzint.org/u/2020/08/GlobalImpactDementia2013.pdf . Accessed January 2024.

[13] . Belcher, V.N., et al., Views of older adults on patient participation in medication-related decision making. J Gen Intern Med 2006;21:298–303.

[14] . Martine T.E. et al., Patient engagement in research with older adults with cancer. Journal of Geriatric Oncology. 2017;8(6):391-396.

[15] . Davis, S.F., et al. Hearing the voices of older adult patients: processes and findings to inform health services research. Res Involv Engagem 2019;5:11.

[16] . Jacobs, R and M. Kane. 9th annual International Conference of Education, Research and Innovation. ICERI2016 Proceedings. 5607-5618.

[17] . Lorem GF, et al., Ageing and mental health: changes in self-reported health due to physical illness and mental health status with consecutive cross-sectional analyses BMJ Open 2017;7:e013629.