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Cognitive health in the Ageing well programme

Cognitive health in the Ageing well programme

Research Team: Dr Louise Lafortune & Prof Carol Brayne

Who's involved: University of Cambridge, Fuse, University of Bristol, Exeter University, University of Sheffield, LiLaC and LSHTM

November 2013 - March 2017

Project summary

Given our ageing population it is vital that older adults make informed lifestyle choices regarding physical, cognitive and social wellbeing. Yet commissioners and providers struggle to develop interventions that tailor to – or at least consider – the specific needs and circumstances of older people. Evidence in this domain can be complex, patchy and of variable quality, particularly for dementia prevention. The resource we developed addresses this.

What does this mean for public health professionals?

The team’s rapid reviews informed NICE’s first ever guidelines on “Dementia, disability and frailty in later life – mid-life approaches to delay or prevent onset”. This is vital as NICE seeks to improve outcomes for people using the NHS and other public health and social care services across the U.K. Their national guidelines are widely used by “commissioners, managers and practitioners, working in the public, private and third sector”, as well as the public.
PHE used the team’s subsequent three reviews in their resource “Changing risk behaviours and promoting cognitive health in older adults – an evidence-based resource for local authorities and commissioners”. It was being disseminated across England to support dementia prevention initiatives.

What does this mean for the public?

There is mounting evidence of the association between damaging lifestyle behaviours and poor health in late life. Yet an alarming proportion of the population continues to smoke, drink and fail to exercise. Public health guidance provides tailored recommendations to promote healthy behaviours in children, the general population and to some extent in older adults. But before the publication of the NICE guidance, few recommendations targeted midlife, a crucial time when behaviours can become entrenched. Our evidence reviews were instrumental in closing this gap.

Life expectancy continues to increase in the UK and it is important that people have the opportunity to spend these extra years enjoying healthy, independent lives.

To help achieve this, the aim of this cross-cutting theme was to contribute to the development and evaluation of preventive interventions for good brain health. The research focused on summarising the evidence to 1) determine the effectiveness of preventive interventions (including lifestyle and diet modification, improving cardiovascular health, social isolation, etc.) and 2) identify whether specific interventions work better depending on an individuals’ level of risk of developing dementia. The team also prioritised practice-focused activities that led to direct influence on policy at the national level.

To kick start this work, the team was commissioned to conduct three rapid evidence reviews to inform the development of NICE public health guidance on mid-life interventions that could prevent or delay the onset of disability, dementia, and frailty in later life. We first looked at the association between risk behaviours in mid-life and late life outcomes such as mortality, disability, dementia, frailty. The second review summarized the effectiveness of interventions to promote healthy behaviours in mid-life. Finally, the third sought to inform the design of tailored interventions for people in mid-life by identifying issues that prevent or limit the uptake and maintenance of healthy behaviours.

The reviews identified specific risk behaviours that can be changed to reduce the risk of dementia, disability and frailty for many people. These include smoking, lack of physical activity, alcohol consumption, poor diet and being overweight. For example, the provision of a structured exercise programme (such as stretching, aerobic exercise, walking, weight training, yoga) can build resolve to start and maintain physical activity. The NICE guidance implements this by recommending local authorities “provide supervised activities and exercise classes”. Similar recommendations are made for other risk behaviours.

Building on that work, the team conducted three additional systematic reviews of studies of older populations living in the community. Two assessed the effectiveness of interventions that promote healthy behaviours and brain health. The third identified barriers and facilitators of behaviour change in these populations. At Public Health England’s request, the team developed an evidence-based resource for commissioners and local authorities based on the reviews’ key findings. It provides a steer to promote healthy behaviours and cognitive health, and for the development of a stronger evidence base.

Publications

Publications
• Kelly S, Olanrewaju O, Cowan A, Brayne C, Lafortune L. Alcohol and older people: a systematic review of barriers, facilitators and context of drinking in older people and implications for intervention design. PLOS One. January 25 2018. DOI: 10.1371/journal.pone.0191189
• Lafortune L, Brayne C. Dementia prevention — a call for contextualized evidence. Nature Neurology Reviews. 2017. 13:579-580. doi:10.1038/nrneurol.2017.136
• Kelly S, Olanrawaju O, Cowan A, Brayne C, Lafortune L. Interventions to prevent and reduce excessive alcohol consumption in older people: a systematic review and meta-analysis. Age and Ageing. 2017. 0:1-10. doi:10.1093/ageing/afx132.
• Lafortune L, Martin S, Kelly S. Midlife Approaches to prevention of ill health in later life. JAMA Internal Medicine. Published online 6 Feb 2017. doi:10.1001/jamainternmed.2016.8849
• Kelly S, Martin S, Kuhn I, Cowan A, Brayne C, Lafortune L. (2016) Barriers and facilitators to the uptake and maintenance of healthy behaviours by people at mid-life: a rapid systematic review. PLOS One. Published online 27 Jan 2016. doi:10.1371/journal.pone.0145074
• Lafortune L, Martin S, Kelly S, Kuhn I, Remes O, Cowan A, Brayne C. Behavioural risk factors in mid-life associated with successful ageing, disability, dementia and frailty in later life: a rapid systematic review. PLoS ONE. 2016. 11(2): e0144405. doi:10.1371/journal.pone.0144405
• Olanrewaju O, Kelly S, Cowan A, Brayne C, Lafortune L. Physical activity in community dwelling older people: a systematic review of reviews of interventions and context. PLOS One. 2016. e0168614. doi:10.1371/journal.pone.0168614
Editorials / Reports / Discussion Papers / Policy Briefing Papers
• Lafortune L, Kelly S, Olanrewaju O, Cowan A, Brayne C. (2016). Changing risk behaviours and promoting cognitive health in older adults: An evidence-based resource for local authorities and commissioners. Public Health England. PHE gateway number: 2016427. https://goo.gl/SSBTYP
• Kelly S, Lafortune L, Martin S, Kuhn I, Cowan A, Brayne C. (2014) Disability, dementia and frailty in later life: mid-life approaches to prevent or delay the onset of these conditions – Evidence review of issues that prevent or limit the uptake and maintenance of healthy behaviours by people in mid-life (barriers and facilitators). NICE Report. http://bit.ly/1Mm4p68
• Lafortune L, Kelly S, Martin S, Kuhn I, Remes O, Cowan A, Brayne C. (2014) Disability, dementia and frailty in later life: mid-life approaches to prevent or delay the onset of these conditions – Evidence synthesis of behavioural risk factors in mid-life associated with successful ageing and the primary prevention or delay of disability, dementia, frailty, and non-communicable chronic conditions. NICE Report. http://bit.ly/1WOSseb
• Lafortune L, Martin S, Kelly S, Kuhn I, Remes O, Cowan A, Brayne C. (2014) Disability, dementia and frailty in later life: mid-life approaches to prevent or delay the onset of these conditions – Effectiveness and cost-effectiveness of mid-life interventions for increasing the uptake and maintenance of healthy lifestyle behaviours and the prevention or delay of dementia, disability, frailty and non-communicable chronic diseases related to modifiable lifestyle risk factors. NICE Report. http://bit.ly/1Mm4nLj

Resources

The NICE PH guidance is published demonstrating direct impact. The protocols for the older people reviews are registered with PROSPERO.

Protocols
• Lafortune L, Kelly S, Martin S, Smailagic N, Cowan A, Brayne C. A systematic review of interventions in older age for increasing the uptake and maintenance of healthy behaviours that may impact on successful ageing. PROSPERO 2014:CRD42014015554 Available from http://www.crd.york.ac.uk/PROSPERO_REBRANDING/display_record.asp?ID=CRD42014015554
• Lafortune L, Kelly S, Martin S, Smailagic N, Cowan A, Brayne C. A systematic review of behavioural interventions in older age for the primary prevention, or delay, of dementia and cognitive decline. PROSPERO 2014:CRD42014015584 Available from http://www.crd.york.ac.uk/PROSPERO_REBRANDING/display_record.asp?ID=CRD42014015584
• Kelly S, Lafortune L, Martin S, Smailagic N, Cowan A, Brayne C. A systematic review of issues (barriers and facilitators) that prevent or limit or that help and motivate the uptake and maintenance of healthy behaviours in older people. PROSPERO 2014:CRD42014015557 Available from http://www.crd.york.ac.uk/PROSPERO_REBRANDING/display_record.asp?ID=CRD42014015557

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Report: Changing risk behaviours and promoting cognitive health in older adults

Changing risk behaviours and promoting cognitive health in older adults: an evidence-based resource for local authorities and commissioners.

 

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