Ageing, Vulnerability and COVID-19

COVID-19 has had a destructive ripple effect on all aspects of society but with a more drastic impact on the most vulnerable and dependent on government services through social protection mechanisms. Among these is population ageing. Already in need and facing challenges of healthy ageing and dependent, especially in Pacific Island countries, on traditional family relations, the general shrinking of resources including able-bodied family members presents a crisis of livelihood for ageing parents. In Fiji, government social schemes have proven inadequate and open up spaces for the resurgence of charity, reciprocity and the "moral economy” as enduring Pacific values. Where then does social protection go from here? This is the question of our times. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2021.

Life Course Education, Health, and Ageing Well: A Short Inter-Academic Report.

After the first wave of the COVID-19 pandemic, during which the severity of the disease in certain countries was attributed to a lack of basic education of the inhabitants, the authors of this paper initiated a literature review of educational trajectories, health, and ageing well. The findings strongly demonstrate that alongside genetics, the affective and educational family environment, as well as the general environment, greatly interact starting from the very first days of life. Thus, epigenetics plays a major role in the determination of health and disease [DOHAD] in the first 1,000 days of life as well as in the characterization of gender. Other factors such as socio-economic level, parental education, schooling in urban or rural areas, also play a major role in the differential acquisition of health literacy. This determines adherence (or lack thereof) to healthy lifestyles, risky behaviours, substance abuse, but also compliance with hygiene rules, and adherence to vaccines and treatments. The combination of all these elements and lifestyle choices facilitates the emergence of metabolic disorders (obesity, diabetes), which promote cardiovascular and kidney damage, and neurodegenerative diseases, explaining that the less well educated have shorter survival and spend more years of life in disability. After having demonstrated the impact of the educational level on health and longevity, the members of this inter-academic group propose specific educational actions at three levels: (1) teachers and health professionals, (2) parents, (3) the public, emphasizing that these crucial actions can only be carried out with the unfailing support of state and academic authorities.

Digital Health Technologies Usage among Older Adults for Healthy Ageing during COVID-19: A Review

Digital health technologies are being increasingly developed with the aim of allowing older adults to maintain functional independence throughout the old age, a process known as healthy ageing. Such digital health technologies for healthy ageing are expected to mitigate the pandemic effects and improve the quality of life of older adults. However, digital health technology diffusion is still in its early stage and there is slow rate of adoption among elderly people. Little is known regarding the needs of older adults regarding digital health technologies during pandemic. More reviews are needed to investigate on this issue so that engagement strategies for a better-quality digital health solution can be develop for promoting healthy ageing later. Therefore, the aim of this paper is to review on the perceptions and digital health technologies usage among older adults for healthy ageing during the COVID-19 epidemic. Summary of digital health technologies issues and recommended strategies for older adults is also presented. Related studies from the articles will be reviewed to highlights potential rooms for improvement for digital health technologies usage within older adults. © 2022 IJETAE Publication House. All rights reserved.

The Influence of Easing COVID-19 Restrictions on the Physical Activity Intentions and Perceived Barriers to Physical Activity in UK Older Adults.

COVID-19 has had profound effects on physical activity behaviours of older adults, and understanding this impact is essential to driving public health policies to promote healthy ageing. The present study aimed to determine; (1) intended physical activity behaviours of older adults following the easing of UK COVID-19 restrictions; (2) the relationship between self-reported physical activity and intended physical activity behaviour; (3) perceived barriers to achieving the intended physical activity goal. Ninety-six participants (74.8 ± 4.4 years; 52 female) from a longitudinal study examining the impact of COVID-19 on physical activity were recruited. Participants outlined their future physical activity intentions and completed the COM-B Self Evaluation Questionnaire. Participants were split into groups based on their intention to 'Maintain' (n = 29), 'Increase' (n = 38) or 'Return' (n = 29) to pre-COVID-19 physical activity. Self-reported physical activity undulated over the pandemic but was mostly equivalent between groups. Intended physical activity behaviour was independent of self-report physical activity. Capability and motivation factors were the most frequently cited barriers to the intended physical activity behaviour, with a greater number of capability barriers in the 'Return' group. Such barriers should be considered in the COVID-19 recovery public health physical activity strategy for promoting healthy ageing.

Health and Care Dependency of Older Adults in Dresden, Germany: Results from the LAB60+ Study.

As the population in Europe ages, an increased focus on the health of older adults is necessary. The purpose of the population-based LAB60+ study was to examine the current health and care situation of the population of older adults in Dresden, Germany, and to assess the effect of age, gender, and socioeconomic status (SES) on health outcomes. In the first half of 2021, 2399 out of 6004 randomly sampled residents of Dresden aged 60 years or older answered questions on their chronic conditions, care dependency, health-related quality of life (HRQoL), and well-being, among others. Of the participants, 91.6% were afflicted with at least one chronic condition, and 73.1% had multimorbidities. More than one-tenth (11.3%) of participants were care dependent. Lower levels of HRQoL and well-being were observed compared to a published German reference population, perhaps because of the ongoing COVID-19 pandemic. Gender differences were observed for some chronic health conditions, and women had a higher risk for lower HRQoL, well-being, and depressivity compared to men. A low SES was associated with a higher risk of the vast majority of health outcomes. Particularly, socioeconomic factors and gender-related inequalities should be considered for the development of prevention and health-promoting measures during late life.

User Perceptions and Needs Analysis of a Virtual Coach for Active and Healthy Ageing-An International Qualitative Study.

Virtual coaching systems show great potential for meeting the challenges of demographic change. However, the proportion of older users in the field of digital technologies is far behind that of younger people. As part of the e-VITA project, semi-structured interviews were conducted in Japan, France, Italy and Germany with 58 people aged 65 and over, and the content was analyzed with the aim of obtaining information about how older adults organize their everyday lives, also with regard to the COVID-19 pandemic, how they deal with their health, what role digital technologies play in the lives of the interviewees and why they oppose progressive digitization. Second, the survey asked why the older adults oppose a virtual coach, which is to be developed in the e-VITA project to support older adults in healthy and active aging, and what barriers they see in a possible implementation. It was found that older respondents lead active, varied lives and that the COVID-19 pandemic contributed to the increased use of digital solutions. In addition, respondents were consciously addressing their own health. With regard to a virtual coach, barriers were seen primarily in the area of data security and sharing. It can be concluded from this that heterogeneity among older user groups should be taken into account when developing virtual coaches. In addition, aspects of data security and data protection should be presented in a clearly understandable and transparent manner.

Impact of COVID-19 on neighbourhood physical activity in older adults

Physical activity is critical for older adults’ health and was particularly important during the coronavirus (COVID-19) pandemic. To slow the spread of COVID-19, built environment modifications were introduced in public spaces including one-way walking systems, social distancing, and the restricted use of public toilets and seating. These modifications intended to encourage safe exercise but may have reduced walkability and inadvertently hindered older adults’ physical activity. We aimed to investigate whether Covid-related built environment modifications reduced older adults’ physical activity. We surveyed 282 older adults in the UK using a mixed methods Concurrent Triangulation Design. Physical activity decreased during COVID-19. Older adults believed many Covid-related built environment modifications negatively affected physical activity because of safety or accessibility issues. These negative modifications were more prominent in areas of higher walkability and associated with reduced physical activity. However Covid-related Traffic Reduction and some elements of One-Way Walking Systems were largely considered positive modifications that helped facilitate physical activity. We concluded common Covid-related built environment modifications hindered exercise, reduced walkability, and possibly contributed to reduced physical activity in older adults. If similar modifications are required in the future, older adults’ needs must be accommodated to avoid discouraging physical activity and compromising long-term health. © 2022 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

Frailty: an overview of concepts, risk factors, assessment tools and interventions.

Frailty is a distinctive health state and a life-limiting syndrome seen in older people and in those living with multiple long-term conditions. It is likely that every nurse will encounter patients living with frailty in their clinical practice, even more so if they work in older people's nursing. People living with frailty are more vulnerable than others to stressors and insults due to a decline in their physiological reserve and function. There are tools that can be used to assess people's frailty or risk of frailty and interventions that can be used to prevent or reduce frailty. This article describes frailty and explains how to assess, prevent and reduce it. The article also outlines the relationship between frailty and coronavirus disease 2019 and the frailty trajectory at the end of life.

Vaccinations and Healthy Ageing: How to Rise to the Challenge Following a Life-Course Vaccination Approach.

In the context of an ageing population, one of the major Public Health goals is to promote healthy ageing. To rise to this challenge, rethinking conventional prevention paradigms and implementing them with vaccination at all stages of life is necessary. Indeed, vaccinations are able to both prevent pathogen specific diseases and all their downstream effects and to increase overall immune system plasticity and resilience. Our aim is to discuss the obstacles and opportunities in pursuing a "life-course vaccination approach" and to highlight the role of vaccines in healthy ageing. In doing so, we address the close connections between immunology and vaccinology advances and introduce the novel concept of immune fitness. Finally, we conclude that even though vaccinology is making giant steps towards tailored vaccination strategies, more studies are needed to investigate this topic.

WisdomOfAge: Designing a Platform for Active and Healthy Ageing of Senior Experts in Engineering

The European population is undoubtedly ageing at an accelerating pace and by 2050;the number the elderly people will increase with almost 50% compared with 2019 numbers. Under the current legislation, the retirement age within most EU countries is 65, when many people are still able to perform within their profession at a decent level due to their knowledge and vast experience. The paper focuses on the design of a digital platform through which the retired seniors are able share their expertise with the younger generations, thus providing a useful, safe, and friendly environment that also addresses current challenges generated by the COVID-19 pandemics. The paper presents the analysis of the most important user needs and challenges that come with the age, sets the main pillars to be considered in the development of the application, both related to the overall architecture and main functions, and the user interface characteristics. A modular user focused design of the digital platform is proposed, by emphasizing its main functions, namely, to provide the means of a seamless interaction and an improved user experience. Artificial intelligence agents will be integrated to improve the matchmaking process by relying on the overall experience during training sessions. © 2021, Springer Nature Switzerland AG.

What helps older people persevere with yoga classes? A realist process evaluation of a COVID-19-affected yoga program for fall prevention.

BACKGROUND: Falls among older people are a major global health concern. This process evaluation investigates the experience of participants aged 60+ in a yoga program aimed at preventing falls which transitioned from studio-based classes to online classes in response to COVID-19 restrictions. We sought to understand how the Successful AGEing (SAGE) yoga program functioned in both settings and as a hybrid program, and to explain why it worked well for most participants. METHODS: Realist process evaluation was used to explore the factors that facilitated a successful transition for most participants, and to consider why it did not work for a minority. This approach develops program theories that describe which mechanisms an intervention is (or is not) activating, and how this is mediated by context to generate process outcomes. Data included interviews with participants (n = 21) and yoga instructors (n = 3), self-report feedback forms (n = 46), observation of classes and routine process measures. RESULTS: Factors that facilitated a successful transition for most participants included the quality of yoga instruction, the program format and inherent characteristics of yoga. Gains in transitioning online included continuity and greater convenience. Losses included perceived reduction in the effectiveness of yoga instruction. There were greater challenges for people struggling with pain and in disadvantageous home environments. We identified six program theories configured around 16 mechanisms: 1. It's worth the effort and 2. In expert hands (these had the same mechanisms: value expectancy, therapeutic alliance and achievement/mastery), 3. A communal experience (these mechanisms were shared experience, social connection, social comparison and peer checking), 4. Putting yoga within reach (accessibility, convenience, gratitude), 5. Building yoga habits (purposeful structure, momentum, accountability and continuity), and 6. Yoga's special properties (embodiment and mindfulness). CONCLUSIONS: This study showed that online delivery of a yoga program for people aged 60+ retained much of the value of a face-to-face program for the majority of participants, and increased the value for some. The structured, communal nature of an organised group program delivered by a skilled instructor, together with yoga's intrinsic focus on mindfulness, facilitated continued engagement and perceived health benefits, despite the change in delivery mode.

Age and Ageing journal 50th anniversary commentary seriesHealthcare for older people in Asia.

Populations in Asian developed economies are rapidly ageing, such that, currently, Hong Kong and Japan have the longest life expectancy at birth for both men and women. However, extended lifespan is not necessarily accompanied by prolongation of health span, such that there is increasing prevalence of frailty and dependency, which translates into increase in complex health and social needs as well as increase in absolute numbers of older adults that require such needs. Consideration of social determinants of healthy ageing would be important in the design of equitable health and social care systems. There is a trend towards development of integrated medical social care in the community in Asian countries. Long-term care insurance and also philanthropic support play a role in the financing of such care models.

A Digital Health Service for Elderly People with Balance Disorders and Risk of Falling: A Design Science Approach.

In this study, a design science research methodology was used aiming at designing, implementing and evaluating a digital health service to complement the provision of healthcare for elderly people with balance disorders and risk of falling. An explanatory sequential mixed methods study allowed to identify and explore the dissatisfaction with electronic medical records and the opportunity for using digital health solutions. The suggested recommendations helped to elaborate and develop "BALANCE", a digital service implemented on the METHIS platform, which was recently validated for remote monitoring of chronic patients in primary healthcare. "BALANCE" provides clinical and interactive data, questionnaire pre and post-balance rehabilitation, tutorial videos with balance exercises and patient-recorded videos of the exercises. This digital service was demonstrated, including five elderly patients with clinical recommendations for balance rehabilitation at home. Finally, the authors conducted two focus groups with the participants and their caregivers as well as with physicians. The focus groups aimed at exploring their satisfaction level, needs of adjustment in the "BALANCE" service and strategies for applicability. The digital healthcare service evaluation revealed a significant potential for clinical applicability of this digital solution for elderly people with balance disorders and risk of falling.

The Iterative Model of Ethical Analysis for Large-Scale Implementation Of ICT Solutions.

This manuscript presents a model and the methodology to understand and define the ethical management of the large-scale implementation of ICT solutions for Active and Healthy Ageing. Based on project expertise, including experience from the Pharaon project Horizon 2020, this model includes an understanding of the main ethical challenges and the development of the necessary guidelines, measures, and tools for different stakeholder profiles. This model extends beyond conventional ethical guidelines, providing a methodology to actively discuss ethical and societal challenges within a project based on interactive and iterative dialogue between the entire value-chain of stakeholders. One of the cornerstones in the analysis of challenges is focused attention on policy and societal issues that emerge during a project. Accordingly, the model includes targeted reflections and tools delivered in the context of the recent Covid-19 pandemic. The tools developed in this process are organised in a guide that can be actively used throughout large-scale implementation projects related to ICT solutions.

Using Realist Evaluation to Understand Process Outcomes in a COVID-19-Impacted Yoga Intervention Trial: A Worked Example.

Realist evaluation offers a valuable way to understand how interventions function and thus how they can be improved and locally adapted. Consequently, realist evaluation is increasingly conducted in parallel with intervention trials. It comprises a clear philosophical foundation and view of causality, pragmatic mixed data collection methods, and a theory-driven approach in which hypothesised program theories are tested and refined. However, detailed methods for data analysis are seldom well-described in realist studies and no clear method for analysing and presenting realist evaluation data has yet emerged. In this methodological paper we use the worked example of our realist process evaluation of the SAGE yoga trial to illustrate an applied process of data analysis and presentation of findings. We show how we drew on other realist studies for ideas, provide examples of six key tasks involved in conducting a realist process evaluation (including coding data and structuring results) and describe strategies that did not work and our rationale for rejecting them. This detailed account of the decisions and methods that worked for us is intended to provide a practical and informed point of departure for researchers conducting a realist evaluation.

The COVID-19 Pandemic, Biogerontology, and the Ageing of Humanity.

The World Health Organization designated the decade 2020-2030 as the "decade of healthy ageing." It is a tragic irony that the year 2020 should begin with a pandemic that is so lethal for older persons. Not only are older persons the most vulnerable to COVID-19 mortality, but many of the mitigation efforts to slow the spread of the virus have imposed yet further emotional and mental health burdens on the most vulnerable among those older than 70 years. To help prevent future infectious disease mortality and suffering, as well as the profound health burdens from the chronic diseases associated with ageing, insights from biogerontology must become an integral part of global public health priorities. The timing is ripe for making the public health aspiration of developing an applied gerontological intervention a reality.