Five keys to healthy (and enviable) ageing

GironaSome 90-year-olds are more active than other 30-year-olds. But there are also others who, at 80, can hardly perform any activities without the support of someone else. Therefore, what are the keys to ageing in a healthy and enviable way? This is answered by the psychologist and researcher of the Envelliment, Cultura i Salut Research Group (Ageing, Culture and Health) (UdG) Pilar Monreal; the Catalan Society of Geriatrics and Gerontology geriatrician and vice-president, Jordi Amblàs; and the nurse and director of the Les Vetes nursing home in Salt, Àngels Teixidor.

1- Healthy habits

It sounds like a cliché, but experts believe that it is essential to maintain healthy habits throughout life. "We have to think that aging begins when we are born", recalls Amblàs, who lists the keys to getting older in a healthier way: "Avoid a sedentary lifestyle, have a good diet and exercise". According to the doctor, there are studies that have shown that the genetic load has a very limited role in how each person ages: "No more than 10%". "The rest, more than 90%, depends on other aspects: some are individual (if the person takes care of themselves or has a disease) and others depend on the environment (environmental pollution or rural environments)". For Teixidor, in addition to promoting healthy habits, the administration should make "physical activities such as yoga" available to citizens in order to grow older in a healthier way "and delay admission to a nursing home as much as possible". And Amblàs adds that it has been proven that designing specific physical exercise programmes for each person "improves the capacity for autonomy and survival". 

2- Activities and motivations

"For active ageing it is important to awaken each person's curiosity and interests, so that they look for activities that are useful to them: from volunteering to starting new studies for the pleasure of learning", proposes Monreal, who stresses that above all you have to listen to "what interests them", because not everyone attaches the same meaning to the same things: "People are moved by what makes sense to them, and if it is useful to others, all the better, because it gives them more meaning". The vice-president of the Catalan Geriatrics Society points out that it has been proven that if someone maintains a social life that is "not only active, but activist", they will age better. "They are older people, but they have high capacities beyond playing cards. They can sign up for university or lead social activities thanks to their knowledge and expertise", defends Amblàs. Teixidor believes that spaces such as civic centres should be promoted where there are staff who can help someone if they arrive in a wheelchair or don't know how to use a computer. "But you don't have to pigeonhole them with services already destined for dependencies. You have to offer activities and services that take into account the life project of each person", says the director of the nursing home. In addition, Monreal believes that places have to be created where different generations can share and interact, and not create "spaces just for the elderly". "Older people also have to say and ask for what they want", she insists.

3- Network of social relations

There are many older people who live alone. But for the UdG researcher, we have to differentiate between two types of loneliness: wanted and unwanted: "It is different to be alone than to feel alone". For those who don't want to be lonely, actions should be promoted from the community point of view. "Volunteers who go to see grandparents, neighbours who accompany them to the doctor or to go shopping. There are already initiatives that are being done and could be done, but this also means resources. If the health world lacks resources, the social sphere, which is the poor sister, just imagine", laments Monreal. The doctor recalls that, precisely during the pandemic, the need and importance of socialisation has become evident: "It has been studied that people with less socialisation have a poorer quality of life and a worse prognosis for their lives". In addition, Teixidor stresses that it is important to have relationships beyond the family to weave "a support network so that when someone is missing, be it a partner or children, you can have help from someone". 

4- Measuring frailty

From a medical point of view, Amblàs believes that medication taken by the elderly should be reviewed. "There is a paradoxical element: as they get older and accumulate more illnesses, they tend to take more medication. But we don't know at what point taking more medication can do more harm than good". Likewise, he believes that medicine should be adjusted to the needs of each person. "Beyond knowing technically how to cure someone, we have to consider what is clinically desirable: perhaps a person prefers to live many years, or live less but maintain their functional autonomy". That is why he believes it would be very useful to introduce the concept of fragility in the healthcare world, and he uses a metaphor to explain it. "When we are born we have a full reservoir of health. As we grow older it empties, but each person empties it at a different rate. To know how the reservoir is, we would have to measure the degree of fragility before choosing a treatment". And he gives an example that has become clear during the health crisis: in the case of an 80-year-old with an "empty reservoir", it makes no sense to consider admission to the ICU, because it would be more harmful. "But if they have a full reservoir, it would make sense".

5- Transform nursing homes

"Nursing homes as we currently understand them have to tend to disappear", says the director of Les Vetes, who argues that it would be better to provide a home support system: "There is nowhere like at home, and now people come to nursing homes reluctantly". In fact, Teixidor explains that, in recent years, the profile of users has changed: before they were people who felt lonely or had been widowed with autonomy, but now the majority are people with a greater or lesser degree of dependency. "It is a profile that would be that of socio-health care, not nursing home care", she points out. The director is committed to a model of "mini cottages" with living units of a maximum of twelve people, where each person has a private space with a bedroom, washbasin, a little kitchen and even an extra room in case a family member comes to visit. 

Monreal also believes that people should be attended to in an individualised way: "No more everyone going to breakfast at 9 o'clock and to the toilet at 10 o'clock". "People-centred care means thinking about the person, not just about their needs, but about what they want". In addition, for the psychologist, nursing homes have to be located in the centre of the villages and open them to offer other services that can be useful for the community. "For example, to allocate a part of the building to a library for all neighbours, so that they are centres for different types of people and for different uses". "Not that they are set aside so that they are not seen", Monreal clarifies. But above all, for Teixidor it is essential to provide nursing homes with "qualified, trained workers, who can earn a good living, and not just ask for a certificate as it is now".