On average, we’re living longer, but we’re not necessarily remaining healthy for longer. Professor Ivan Bautmans, head of the Frailty in Ageing research group at the Vrije Universiteit Brussel, wants to change this. Based on his expertise in gerontology, the study of ageing, he is coordinating an advisory group of the World Health Organization (WHO) with a focus on healthy ageing. “There’s a need for a paradigm shift within healthcare,” says Bautmans. “We need to focus on prevention and not wait for things to go wrong. By then, it’s often too late for our older population.”
The United Nations has declared the 2020s to be the Decade of Healthy Ageing. But what do they mean by this? “Healthy ageing is based on what we call intrinsic capacity,” Bautmans says. “These are the reserves that everyone has, physically, emotionally, psychologically, combined with the environment in which a person must use these reserves. The interaction between our reserves and the environment determines our level of functioning. It’s on the basis of that level of functioning that the WHO defines healthy ageing: the opportunity to maintain an adequate level of functioning that contributes to well-being at an older age. To be able to monitor that properly, we also need to be able to quantify it. Intrinsic capacity is divided into various areas such as the locomotor or musculoskeletal system, the cognitive system, the sensory system such as hearing and sight, and vitality. Vitality, or life force, is the underlying biological mechanism, the condition that allows the other domains to develop.”
To ensure optimal monitoring, the WHO relies on the expertise of Bautmans and his colleagues. “The WHO wants to move from a sickness-based model to a function-based model. They asked me to set up and coordinate a working group that looks at the operational definition of vitality. In the autumn, there was a two-day consultation with more than 20 international experts on the definition of vitality capacity. Based on this, we made a shortlist of potential biomarkers, indicators by which we can measure and monitor someone’s vitality capacity.”
The researchers proposed three groups of indicators. The first group deals with energy and metabolism. The second focuses on neuromuscular function and the third looks at immunity, inflammation and the body’s stress response. “For the two first domains, we at VUB have already developed a high-performance e-health system to measure and objectify the indicators.” It’s this expertise in monitoring by the VUB research group that’s so relevant for the development of a new senior policy. But how can it be implemented on a global scale? “There are experts from various countries and regions involved,” says Bautmans. “The recommendations need to be implementable around the world. So you also have to bear in mind cultural differences, the availability of technology and how easy it is to reach the target group. In April, we met with the technical working group in Geneva to develop recommendations on how we can measure and monitor healthy ageing around the world.”
In Belgium too, there is still lots of work to do. “The problem is that our health system currently only focuses on identifying limitations among older people,” says Bautmans. “Older people who have fallen, people who can no longer manage… But we come to that too late, systematically. There isn’t enough focus on prevention. We have to intervene when the intrinsic levels are decreasing. That doesn’t automatically translate into a limitation. Limitations only occur when reserves are so depleted that a person can no longer function at a reasonable level. At that point, it’s very difficult, or even impossible, to turn the situation around. Yet we know that with cheap, safe interventions, we can improve intrinsic capacities earlier and allow people to live independently for longer. Because that’s what we need. People need to be able to live at home for longer and live independently. Otherwise it becomes unaffordable for the healthcare system.”
There are three pillars that people can focus on when it comes to healthy ageing: nutrition, exercise and limiting inflammation. “With physical training, you can see spectacular results,” says Bautmans. “We also have a project running on this. More than 200 older people work out three times a week at the Basic-Fit in Jette. They work on muscle strengthening exercises and their muscle power increases phenomenally. We’ve also demonstrated that there’s a positive effect on the immune system. This is how we work on the underlying processes. The immune system performs better, so the participants are more resistant to infections and become sick less often. When people become exhausted, nine times out of 10 this is related to dormant inflammation in the body. This drains the energy reserves until you’re so weakened that you start to stumble, fall and break a hip. Because of the inflammation you already have, you’re less likely to recover and more likely to contract an infection in hospital. Then you end up in a negative spiral that’s hard to stop. This is why we need a paradigm shift. Focusing on prevention and not waiting until things go wrong is the message. That’s what we want to implement with our interdisciplinary research programme on Active and Healthy Ageing, also in collaboration with the WHO. We want to set up healthy ageing centres, or vitality centres. Places where older people who are still able to look after themselves can get advice and guidance on how to age healthily and actively.”