Age CARE

As people live longer and healthier lives the concept of old age needs to be redefined. Otago's Collaboration of Ageing Research Excellence (CARE) brings together local, national and international research expertise to help us plan better for the “Age of Ageing” and its implications for communities, health care and public policy.

The human body does not arrive with a user's manual giving instructions as to how to get the best out of it.

But we do know a lot about caring for it when it's new and maintaining it as we age, and we're getting better at fixing it when it goes wrong, even down to making and fitting replacement parts and providing social support.

So, in most of the developed world, we are living healthier and longer lives than ever. That's a plus for individuals, but presents society with a number of new challenges.

We have reached the “Age of Ageing”, says Associate Professor Debra Waters. And although ageing populations now feature in the media and on government agendas, we still have much to learn.

Waters is Director of the University of Otago's new research theme CARE – Collaboration of Ageing Research Excellence – with five years' funding to study all aspects of ageing.

CARE grew from the establishment of the Network of Ageing Research at Otago University (NAROU), which joined the International Association of Gerontology and Geriatrics (IAGG) and the Global Ageing Research Network (GARN) in 2011 – and from Waters' role as the Director of Gerontology Research.

With initial funding from Health Research South at the University of Otago, Waters and colleagues rebranded the network to CARE. In its first year it grew from 25 researchers to 60, with local, national and international connections, leading to CARE earning research theme status and support in 2016.

Waters' says that without the excellent work of CARE's steering committee and advisory group, it would have taken much longer to get to this point.

What started as a network of people working loosely together has now united Otago's research talents across public health, policy, sociology and basic sciences with investigators from not only all the Otago campuses and Otago Polytechnic, but also universities in Auckland, Australia, the USA and Canada, and across Europe including France, the Netherlands and the UK.

Waters' service to multiple gerontology organisations has helped foster many long-term collaborations. She is currently vice-president of the New Zealand Association of Gerontology, and on the management team of the Ageing Well National Science Challenge led by Otago's Professor David Baxter.

Waters' own research strengths parallel CARE's main aims, particularly investigating ageing relating to physical health and the loss of skeletal muscle and function (sarcopenia) and interventions to reverse frailty.

Many people today are keeping healthier and living longer, and babies born today have the potential to live longer still. With fewer children being born, current and future populations will become increasingly skewed towards older people.

New Zealand records show that in 2001 those aged 65 and older comprised 11 per cent of the population. By 2051 that's forecast to more than double to 24 per cent, some 1.22 million people.

Similarly, the numbers of those aged 85 and older are expected to increase sixfold, from about 50,000 in 2001 to almost 300,000 in 2051.

“People are living healthier, longer lives and that's what CARE wants to see,” says Waters, “but it means we are having to revisit our definitions for older people.

"We tended to define people over 65 as old, even using the pejorative term 'elderly' to refer to them. Now even the oldest old, those 85 and older, are challenging stereotypes and changing the way we think about ageing.”

So is 60 the new 40? “That may be a stretch, but maybe 75 is the new 65. We're already working with the concept that people might not be considered older adults until 75 plus. Some recently funded research in New Zealand is using this definition, although this is not necessarily the case for those of Māori or Pacific Island descent, who tend to age younger. This is a disparity we would like to see change.”

Another impending change that needs to be addressed is retirement. “With living longer and having fewer children, we are likely to be seeing people working past current retirement ages if they are to keep going both physically and financially.”

Research shows that keeping busy is crucial to living the good life. “We need to stay active in retirement, whether we are still in paid work or not.

“Keeping physically and mentally fit and socially connected makes all the difference. It's important not just to keep active in body – you also need to keep your mind engaged for as long as you can."

“The University of the Third Age is a great concept for continuous learning throughout your life. And volunteerism is a fabulous thing – Age Concern survives because of it.”

In the Otago/Southern region CARE has close connections with Age Concern Otago, as well as many other age-service agencies including Otago Partners for Elders' Needs, Arthritis New Zealand, the Otago Pacific Trust, the Dunedin City Council and the Southern District Health Board. Other CARE members have similar connections in Canterbury, Christchurch, Wellington and the Auckland region.

Local collaborators and researchers are drawn from Otago's biomedical sciences, clinical practice, public and indigenous health, the social sciences, population and community health, rural health and health service providers.

With such a line-up of expertise and experience, are we likely to see CARE promoting top 10 tips for ageing gracefully? Is there a guide for older people to get older still? Waters says it's already happening.

“Age Concern already does a really nice job of that. And ACC is now talking about wellness in holistic terms. General practitioners, researchers and policy-makers are starting to work together on how to help support people to age well and live in their own homes independently for longer.

“Age Concern Otago's Steady As You Go falls prevention exercise programmes are run by peer leaders in local communities and are effective as well as very sociable. But you have to take exercise seriously. You can't just do a programme for 10 weeks and then stop and expect the benefits to stay with you. You have to make the effort to keep it going.”

Fortunately, programmes such as Steady As You Go and Tai Chi have been very successful in retaining participants, with some classes running since 2003. “What keeps people coming back? The social connection. It's just one of the benefits of group physical exercises. Participants see the dramatic improvement in their function and want to maintain it. Classes are fun, social and keep the brain active. Even ACC appreciates that there are important social benefits as well as physical.

“Another element that is gaining attention is the importance of spirituality as we age. That's not a religious concept, but could be described as finding something that nurtures your soul, such as the peace some people find in a garden or in nature or in going for a walk, nurturing mental and emotional health. We are fortunate to have leading researchers in this area as part of the CARE steering committee and network.”

Waters is discovering new challenges. As part of her investigations into body composition and physical function during ageing, she was involved with screening for pre-frail participants for a multicentered trial in regions around Auckland and in Invercargill.

“We were somewhat surprised to find it very hard to recruit subjects who are over the age of 75 and fit the inclusion criteria for pre-frailty. They wanted to be in the trials, but many were not frail enough.”

Discussions with Waters' colleagues in France led to scrutiny of how questions about frailty were being asked, despite there being many validated questionnaires.

“Frailty research has been quite focused on a 'deficit model' that asks people what they are not capable of or how they have lost capacity. We wonder if we should have been asking what they were capable of. It's natural not to want to admit to being a bit frail, which has obvious implications for whether or not you can still live independently, so to get honest answers, maybe we might need to ask different questions.

“We have been having many conversations about this because it could change the way a lot of ageing research is done.

“International co-operation helps us to see how research in one environment compares with others and what might be different. Research in rural Southland equates to rural elements in other parts of the world such as France, where there is an active outdoors culture. Urban research is more likely to equate to some big cities that were never built to encourage getting outdoors. ”

Finding the right topics to investigate is crucial. “We have to ask ourselves what are the most important questions. To do that we talk to stakeholders and community members to find out what matters to them. When they realise you want to hear what they have to say – you want to answer the questions they have – you get instant buy-in. It's an exciting time to be engaged with research that is a collaboration with older people, elder service providers and policy-makers.

“We're learning a lot about what we need to focus on in the next 10 years. There are going to be some huge questions that we have to deal with and understand better."

“Is screening for falls and frailty in general practice effective for identifying people at risk and for increasing referrals to appropriate intervention? Do all older adults want to stay in their own homes and what is needed to make this possible? How many choose to move to retirement villages and do we need more? Who should decide how retirement villages are designed and staffed? How do we train, pay fairly and support care workers, including family members? How do we attract doctors and other health professionals to specialise in geriatrics? Why do some people age better than others, and how do we start a conversation about providing dignity in death?

“These questions and many more cut across all cultures in multicultural New Zealand.”

CARE's research is expected to bring significant benefit to New Zealand in understanding health and the health sector, public policy and local communities. CARE's international exposure is building the profile of gerontology at Otago, attracting researchers to New Zealand and students to Dunedin.

“What is so exciting is that the networks we started continue to expand and bring together not only researchers, but stakeholders and other organisations in the area of ageing,” says Waters. “Our goal is to graduate to Centre of Research Excellence status, which would allow us to expand our knowledge and resources and attract more science collaborators and more stakeholder and community investments.

“We also want to future-proof by getting more students into gerontology. We need younger people because sooner or later we'll be joining the ageing population ourselves – and it's important to continue the positive energy and commitment of all those currently working in this area to help New Zealanders age well.”

Story: Nigel Zega
Photo: Alan Dove