We recently published an evidence-based resource to support local authorities, commissioners and providers to promote cognitive health in older adults aged 55 and above.
This is an important issue because, whilst the fact that people are living longer lives is a public health success story, we know that many of these extra years are spent in ill health or disability.
The next challenge for the health and social care sector is to support individuals to prevent ill health in later years and increase healthy life expectancy, so it's crucial that older adults are supported to maintain and improve their physical, mental and social health and wellbeing.
An alarming proportion of mid-life and older adults are physically inactive, smoke, misuse alcohol, have poor eating patterns and are socially isolated, putting them at risk of substantially increased mortality and ill health.
There is increasing appetite among commissioners and providers to develop and scale up cost-effective public health interventions that meet the health and wellbeing needs of older adults, to promote healthy lifestyle behaviours in this specific population.
Our new report looks at the evidence behind key lifestyle interventions, all of which have evidenced benefits for physical health, but with a specific focus on the impact for cognitive health.
Good cognitive health in older age is important to help reduce the risk of dementia and other health conditions, while declining cognitive health is linked to social isolation and reduced independence.
The resource is based on three systematic reviews conducted by the Cambridge Institute of Public Health (CIPH).
The systematic reviews of the scientific literature look at the effectiveness of interventions to promote healthy lifestyle behaviours and cognitive health in older adults aged 55 and above, and the challenges and enablers of behaviour change in this population. This resource is based on the findings of these three systematic reviews.
Multicomponent: There is preliminary evidence that multicomponent interventions targeting three or more healthy behaviours could have beneficial effects on maintaining or improving cognitive function in older adults. Further evidence is required and a number of studies are ongoing.
Alcohol: For older adults, the effectiveness of interventions to promote healthy drinking behaviour has been understudied. Simple interventions such as performing an assessment may have a positive impact on alcohol behaviour in older adults at risk, and more intensive interventions such as personalised feedback are likely to be more effective at changing behaviour. The impact of drinking on social engagement in light of potential benefits of social participation for cognitive health should also be taken into account.
Smoking: The effect of smoking cessation interventions on outcomes for cognitive health in this cohort has also been understudied. All the interventions examined had some beneficial effects on smoking behaviour, yet more intensive interventions with extended support and follow up could be more effective for older adults. Further studies are needed to assess the cost-effectiveness of smoking cessation interventions for older adults, and the impact on disadvantaged and minority groups.
Diet: The evidence suggests that a range of dietary interventions can be effective in improving diet, including community nutrition education sessions and self-help manuals. Diet interventions delivered during the transition to retirement can be effective and sustainable in the long term. Again, further research is needed to assess cost-effectiveness.
Physical activity: For older adults, there is evidence that physical activity can have beneficial effects on maintaining or improving cognitive health, and reducing the risk of dementia, yet evidence on how much activity is required to produce this effect is lacking.
Cognitive stimulation: There is evidence that cognitive training interventions in older adults can have beneficial effects on cognitive function in healthy participants. Less evidence is available for people with mild cognitive impairment, and there is currently little evidence relating to the longer term impact of these interventions on prevention or delay of dementia.
Social: The available evidence on the beneficial effects of interventions to promote social engagement or activity is limited, but some studies show that interventions involving group participation in educational, social activity or support programmes can reduce social isolation in older adults.
Leisure activity: There is preliminary evidence that leisure activities can have beneficial effects on cognition in older adults, including reading, playing games or reading music. All interventions were conducted in community settings.
- To strengthen the evidence base, the development and implementation of interventions should incorporate evaluation to monitor outcomes and determine cost-effectiveness.
- Efforts should focus on developing and implementing guidance, policies and interventions to reduce smoking and alcohol consumption across the population, including in older adults, as this is beneficial for a range of health outcomes.
- In the absence of evidence on the effective minimum level of physical activity for maintaining brain health, public health messages should promote acceptable levels of physical activity above normal daily activities in older adults.
- Programmes can be designed to be inter-related, for example physical activity programmes can also be opportunities to socialise of be mentally active.
- Programmes for older adults should be evidence-based, tailored and consider the best ways to engage older adults who may have more entrenched behaviours.
- Further studies are needed to determine the longer-term effect of interventions as well as cost-effectiveness and impact on disadvantaged and minority groups.
The evidence tells us that it is ‘never too late’ to influence and change lifestyle behaviours and improve health outcomes in the older adult population. The health and social care system has been successful in increasing longevity, but must now come together under the prevention agenda to help make sure those longer years are healthy.