Research
Researchers uncover factors linked to optimal ageing
A new study followed more than 7,000 middle aged and older Canadians to identify the factors linked to wellbeing as we age.
What is the secret to ‘successful’ or optimal ageing? Researchers in Canada say weight, income, lifestyle, physical activity and sleep likely play a fundamental role.
A new study followed more than 7,000 middle aged and older Canadians for approximately three years to identify the factors linked to wellbeing as we age.
They found that those who were female, married, physically active and not obese and those who had never smoked, had higher incomes, and who did not have insomnia, heart disease or arthritis, were more likely to maintain excellent health across the study period and less likely to develop disabling cognitive, physical, or emotional problems.
As a baseline, the researchers selected participants who were in excellent health at the start of the approximately three-year period of study. This included the absence of memory problems or chronic disabling pain, freedom from any serious mental illness and absence of physical disabilities that limit daily activities — as well as the presence of adequate social support and high levels of happiness and life satisfaction.
“We were surprised and delighted to learn that more than 70 per cent of our sample maintained their excellent state of health across the study period,” says the first author, Mabel Ho, a doctoral candidate at the University of Toronto’s Factor-Inwentash Faculty of Social Work (FIFSW) and the Institute of Life Course and Aging.
“Our findings underline the importance of a strength-based rather than a deficit-based focus on ageing and older adults. The media and research tend to ignore the positive and just focus on the problems.”
There was considerable variation in the prevalence of successful ageing based on the respondents’ age at the beginning of the study. Three quarters of the respondents who were aged 55 to 64 at the start of the study period maintained excellent health throughout the study. Among those aged 80 and older, approximately half remained in excellent health.
Ho adds: “It is remarkable that half of those aged 80 and older maintained this extremely high bar of cognitive, physical, and emotional well-being across the three years of the study. This is wonderful news for older adults and their families who may anticipate that precipitous decline is inevitable for those aged 80 and older.
“By understanding factors associated with successful ageing, we can work with older adults, families, practitioners, policymakers, and researchers to create an environment that supports a vibrant and healthy later life.”
Older adults who were obese were less likely to maintain good health in later life. Compared to older adults who were obese, those who had a normal weight were 24 per cent more likely to age optimally.
David Burnes, associate professor at the University of Toronto’s FIFSW and a Canada Research Chair in Older Adult Mistreatment Prevention, comments: “Our findings are in keeping with other studies which have found that obesity was related to a range of physical symptoms and cognitive problems and that physical activity also plays a key role in optimal ageing.
“These findings highlight the importance of maintaining an appropriate weight and engaging in an active lifestyle throughout the life course.”
Income was also an important factor. Only about half of those below the poverty line aged optimally compared to three-quarters of those living above the poverty line.
“Although our study does not provide information on why low income is important, it is possible that inadequate income causes stress and also restricts healthy choices such as optimal nutrition. Future research is needed to further explore this relationship,” says senior author Esme Fuller-Thomson, director of the Institute for Life Course and Aging and Professor at the University of Toronto’s Factor-Inwentash Faculty of Social Work.
Lifestyle factors are associated with optimal health in later life. Older adults who never smoked were 46 per cent more likely to maintain an excellent state of health compared to current smokers. Previous studies showed that quitting smoking in later life could improve survival statistics, pulmonary function, and quality of life; lower rates of coronary events, and reduce respiratory symptoms. The study found that former smokers did as well as those who had never smoked, underscoring that it is never too late to quit.
The study also found that engaging in physical activity was important in maintaining good health in later life. Older adults who engaged in moderate to strenuous physical activity were 35 per cent to 45 per cent more likely to age well, respectively.
The findings indicated that respondents who never or rarely experienced sleep problems at baseline were 29 per cent more likely to maintain excellent health across the study.
Fuller-Thomson adds: “Clearly, good sleep is an important factor as we age. Sleep problems undermine cognitive, mental, and physical health. There is strong evidence that an intervention called cognitive-behavioral therapy for insomnia (CBT-I) is very helpful for people living with insomnia.”
The study was recently published online, in the International Journal of Environmental Research and Public Health.
NICE will review whether new Alzheimer’s drugs should be offered on the NHS after an appeal found their wider impact was not fully counted.
An appeal found that the National Institute for Health and Care Excellence had failed to properly account for the wider impact of the treatments, including the heavy burden on unpaid carers, when calculating the cost effectiveness of the medicines.
Both treatments, lecanemab and donanemab, will now return to a NICE committee for further consideration.
“Today’s ruling is an opportunity for NICE to consider the real cost of Alzheimer’s on people and their families, and we welcome the decision to look again at whether new medicines could be provided on the NHS,” said David Thomas, head of policy and public affairs at Alzheimer’s Research UK.
Lecanemab and donanemab do not cure Alzheimer’s, but they slow it by targeting and clearing clumps of amyloid proteins, sticky protein build-ups in the brain linked to the disease.
While the drugs are available privately in the UK for people who can afford them, NICE ruled last year that they were too expensive to be made available on the NHS in England and Wales.
It is estimated informal dementia care costs the economy more than £20bn a year.
Alzheimer’s Research UK wants NICE to update how it assesses the value of new dementia drugs and factor in the huge additional costs this condition places on society and the wider economy.
NICE and its expert committees assess whether new drugs are good value for money for the NHS based on a wide range of evidence.
This includes how treatments perform in clinical trials, the experiences of patients and carers, and the costs of new drugs as well as any changes to NHS services needed to provide access.
When NICE weighs up whether a new Alzheimer’s drug is cost effective for the NHS, it carries out a limited assessment of the impact dementia has on the health of carers.
But the condition takes an enormous toll on families and society because caring for someone with dementia can lead people to become more isolated and give up work.
It can have a major emotional impact and put families under financial strain.
Thomas said: “Research has delivered new treatments with the potential to provide people with valuable extra months of independence, lessening the burden on carers.
“While these treatments offer modest benefits and can cause serious side effects, they provide the foundation for a future where dementia becomes a treatable condition.
“Now we need NICE to look again at how these medicines could benefit both people with early Alzheimer’s and their carers.”
Chris, whose mother Shirley is living with Alzheimer’s disease, said: “The real cost of Alzheimer’s is far greater than many people realise.
“In order to give my mum the care she needed, I moved back home to help my dad as the care was too much for him alone. After my dad passed away from Covid in 2021, I became sole carer for my mum.
“It was a very difficult period, working a full-time job, caring for Mum and dealing with the loss of my dad. Eventually I got some in-home care support to help.
“The family has borne most of the cost of Mum’s care, both in time and fees, and the family home has been sold to finance it.”
“The emotional and financial strain Alzheimer’s has taken on our family is horrendous, and I know many families across the UK are experiencing this pressure.”
He is backing Alzheimer’s Research UK’s call for NICE to change how it evaluates new dementia treatments.
The timeframe for the next NICE meetings to discuss the drugs is still to be set, and it is not certain follow-up hearings would change NICE’s guidance on access to the medicines.
But Alzheimer’s Research UK is continuing to push to make sure dementia is now a main priority for political and NHS decision-makers.
The head of the ongoing independent review into adult social care, Baroness Louise Casey, has called on the government to act, show leadership and prioritise dementia.
She has proposed appointing a dementia tsar to drive forward the prevention, treatment and care of dementia.
Baroness Casey has also argued for more funding for dementia treatment trials.
With more than 130 Alzheimer’s drugs in clinical trials worldwide, the charity says it is vital the NHS runs trials of new treatments now to understand how to deliver them to eligible patients in future.
In addition to changing how NICE assesses new medicines, the health service needs to collect real-world evidence on new dementia drugs and prepare for diagnostic tests and innovative treatments that are coming.
“Alzheimer’s Research UK is calling on the government to give dementia the same political determination that transformed cancer care,” Thomas said.
“We urgently need investment and a clear UK-wide plan so new treatments can be assessed in the NHS and reach the people who stand to benefit.”
Health and social care secretary Wes Streeting has said dementia is “one of the greatest challenges of our time” and pledged that the UK should become a world leader in dementia clinical trials.
Osteoporosis drugs may lower dementia risk, with a study suggesting one widely used treatment could help prevent Alzheimer’s and related dementias.
The research found that nitrogen-containing bisphosphonates, drugs widely used to treat osteoporosis, may significantly reduce the risk of Alzheimer’s disease and related dementias in older adults with osteoporosis or fragility fractures.
Osteoporosis and dementia often coexist in older adults and share several risk factors, including advanced age, female sex and reduced physical activity.
Researchers at the University of Hong Kong’s department of pharmacology and pharmacy carried out a large study using the city’s electronic medical records, covering more than 120,000 patients aged 60 and above with osteoporosis or fragility fractures between 2005 and 2020.
The team found that NBP users had a 16 per cent lower risk of developing Alzheimer’s disease and related dementias than untreated patients, and a 24 per cent lower risk than those who received other osteoporosis medicines.
The association was especially marked in women and patients with hip fractures.
The researchers estimated that treating 48 patients with NBPs for five years could potentially prevent one case of dementia, underlining the possible public health value of NBPs in high-risk groups.
Professor Cheung Ching-lung, associate professor in the department of pharmacology and pharmacy at the University of Hong Kong, said: “Our study provides evidence that NBPs may offer dual benefits in strengthening bones and reducing fracture risk, as well as potentially preventing ADRD.
“Their potential neuroprotective role provides an empirical basis and supports future research on the actual effectiveness of this medication in preventing or delaying cognitive decline associated with ADRD.
“These findings are significant as they demonstrate a potential approach for reducing dementia risk in a vulnerable population using safe and widely available NBPs.
“In our rapidly ageing society, these findings suggest that while waiting for the novel therapies, existing medications can also provide additional protection for high-risk populations.”
The same research team has previously found that osteoporosis and fractures are independent risk factors for dementia, and that patients with dementia are at higher risk of falls and fractures.
This suggests treating osteoporosis may also help reduce the burden of dementia.
NBPs, including alendronate and zoledronate, are well established and commonly prescribed osteoporosis drugs.
Emerging biological research suggests the pathways affected by NBPs may also play a role in the development of Alzheimer’s disease and related dementias, raising the possibility that they could be repurposed for prevention.
A prebiotic fibre supplement may ease arthritis pain and improve grip strength in people with knee osteoarthritis, a study suggests.
The daily supplement, made from inulin, a dietary fibre found in chicory root, Jerusalem artichokes and other vegetables, also lowered pain sensitivity and saw fewer people drop out than a digital physiotherapy programme tested alongside it.
Dr Afroditi Kouraki, lead author of the study from the University of Nottingham, said: ‘Our findings suggest that targeting gut health with a prebiotic supplement is a safe, well-tolerated, and effective way to reduce pain in people with knee osteoarthritis.
“The very low dropout rate compared to the exercise group is also encouraging from a public health perspective, people were able to fit this supplement easily into their daily lives.’
Osteoarthritis of the knee, a wear-and-tear joint condition, affects hundreds of millions of people worldwide and is a leading cause of pain and disability, particularly in older adults.
Current treatments rely heavily on pain medication, which can cause side effects, or exercise programmes, which many patients find hard to maintain.
The INSPIRE trial, led by researchers at the University of Nottingham, involved 117 adults with knee osteoarthritis and tested four groups: inulin alone, digital physiotherapy-supported exercise alone, a combination of both, and a placebo. Both inulin and physiotherapy independently reduced knee pain.
However, inulin alone improved grip strength and reduced pain sensitivity, measures linked to how the nervous system processes pain, while physiotherapy did not.
The dropout rate for those taking the supplement was just 3.6 per cent, compared with 21 per cent for the physiotherapy group, suggesting a daily supplement may be easier for people to stick with than an exercise programme.
Inulin works as a prebiotic, meaning it feeds beneficial bacteria in the gut.
This leads to the production of compounds called short-chain fatty acids, particularly butyrate, which can affect inflammation and pain pathways throughout the body.
Participants taking inulin also showed increased levels of both butyrate and GLP-1, a gut hormone linked to pain regulation and muscle health.
Higher GLP-1 levels were associated with improved grip strength, pointing to a possible gut-muscle connection.
Senior author Professor Ana Valdes added: ‘The link we observed between GLP-1 and grip strength is particularly intriguing and points to a broader gut-muscle-pain axis that warrants further investigation. This could have implications not just for osteoarthritis, but for understanding how gut health influences ageing and physical resilience more broadly.’
Professor Lucy Donaldson, director of research at Arthritis UK, said: “The pain of arthritis can severely impact quality of life. Our recent lived experience survey showed that six in ten people are living in pain most or all of the time due to their arthritis.
“Researchers are starting to explore the role of the gut microbiome in our experience of pain.
“This exciting preliminary research highlights how diet and physiotherapy can act in different ways to have benefits for people with arthritis.
“We know a variety and balance of healthy foods, including fibre, and regular physical activity matter, and we’re glad to be supporting research that explores how they work to help people with arthritis.”
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