7 Tips for Healthy Ageing

Whilst celebrating the positive aspects of ageing we also need to recognise the realities of some age-related changes, such as decline in sensory abilities and the impact of chronic health conditions such as cardiovascular disease and dementia. There is a disparity between healthy life expectancy and average life expectancy. The challenge is to build a society with a long healthspan as well as a long lifespan. Prevention of cognitive decline is a key factor in healthy ageing as cognitive decline leads to physical decline.

According to the World Health Organization (WHO), there are 50 million people with dementia, with 10 million new cases each year. In 2018, the WHO Guideline Development Group met to evaluate and discuss the evidence for different dementia prevention strategies. Interventions to prevent dementia are most effective if introduced before the first symptoms of dementia appear, around the age of 50 (1).

The 7 lifestyle factors identified by the WHO are (2):

1. Physical activity

People who are physically active have a reduced risk for cognitive decline, Alzheimer’s disease and dementia as well as cardiovascular disease and cancer. Physical activity includes sports, walking, cycling, and household chores. For adults aged 65 years and above, the WHO recommends 150 minutes or more of moderate-intensity physical activity per week, or 75 minutes or more of vigorous-intensity physical activity per week, or a mixture of both moderate and vigorous exercise. A Japanese study found that walking more than three times per week helps prevent dementia (3).

2. Nutrition and diet

Dietary habits that increase the risk of cardiovascular and metabolic diseases also increase the risk of dementia. Dietary intervention should be introduced as early as possible to minimise risks.  There are many different healthy diets, but the Mediterranean diet rich in antioxidants, fibre and omega 3 fats is the most extensively studied diet that is found to be protective against neurodegeneration. The Mediterranean diet consists of fruits, vegetables, whole grains, fish, poultry, legumes, nuts, mono-unsaturated fats and low-to-moderate alcohol with limited amounts of red meat and dairy.

A study looking at the relationship between lifestyle habits and dementia risk in Japan found that Japanese-style dietary habits, both in terms of food and eating regimes, correlate with a decreased dementia risk (3). Intermittent fasting may also be recommended.

Certain nutrients may be beneficial against cognitive decline including glutathione, polyphenols, curcumin, coenzyme Q10, folic acid, omega 3 fats, lecithin, caffeine, some probiotics and vitamins B6 and B12.

3. Quit smoking

Smoking cigarettes is associated with many health risks, including several types of cancer, cardiovascular disease, asthma, chronic obstructive pulmonary disease and dementia. Behavioural interventions to help with stopping smoking include counselling, mindfulness-based approaches, cognitive behavioural therapy and others. Drug therapies include nicotine replacement therapy, bupropion, and varenicline. Combinations of both behavioural and pharmacological approaches may be the most effective (4).

4. Reduce alcohol use

While it is not clear whether light to moderate drinking of alcohol is protective or harmful to brain health it is clear that excessive alcohol consumption is a definite risk factor for dementia and cognitive decline.

Behaviour and psychological interventions include cognitive behavioural therapy, motivational enhancement therapy, family counselling and self-help groups such as AA. Drug interventions include medications that treat withdrawal symptoms or prevent relapse, but these treatments may have adverse side effects (5).

5. Cognitive interventions

Lifelong learning is associated with cognitive health and higher levels of cognitive activity at mid- or late-life are linked to delayed onset of cognitive impairment (6). It’s never too late to learn a new skill whether it’s another language, a musical instrument, dancing or cryptic crosswords.

6. Social activity

Social isolation is a risk factor not only for dementia but also for hypertension, coronary heart disease and depression. Low social participation, fewer social contacts, and more loneliness have all been associated with increased dementia risk.  Social participation and social support are strongly connected to overall health and well-being and should be encouraged throughout life (7).

7. Weight management

Observational studies have reported that people who are obese in midlife have an increased risk of dementia, type 2 diabetes, cancer and cardiovascular disease compared to those with healthy body weight. The WHO recommendations for people who are overweight and obese include: 1) eat a healthy balanced diet, 2) eat low glycaemic-index foods (beans, lentils, oats, and unsweetened fruit) as their sources of carbohydrates, and 3) reduce sedentary behaviour while increasing physical activity. Lifestyle interventions that include both diet and physical activity have been reported to produce the best results (8).

Numerous population-based longitudinal studies suggest an association between modifiable lifestyle factors and late-life dementia (9). The good news is that it’s never too early or too late to take steps to reduce your risk for cognitive decline and dementia.

See also blog posts Think Well, Age Well and Healthy Ageing for more information on how to age well.

References

1. Rocz Panstw Zakl Hig. 2021;72(1):29-39. The role of nutrition in Alzheimer’s disease. Sliwinska S, Jeziorek M.

2. WHO (2019) WHO Guidelines: Risk reduction of cognitive decline and dementia.

3. Geriatr Gerontol Int. 2021 Feb;21(2):203-208. Lifestyle habits and the risk factors of dementia: Evidence from Japan. Chen F, Yoshida H.

4. Anstey KJ, von Sanden C, Salim A et al. (2007) Smoking as a risk factor for dementia and cognitive decline: a meta-analysis of prospective studies. Am J Epidemiol 166, 367-378.

5. Langballe EM, Ask H, Holmen J et al. (2015). Alcohol consumption and risk of dementia up to 27 years later in a large, population based sample: the HUNT study. Eur J Epidemiol 30, 1049-1056.

6. Vemuri P, Lesnick TG, Przybelski SA et al. (2014). Association of lifetime intellectual enrichment with cognitive decline in the older population. JAMA Neurol 71, 1017-1024.

7. Kuiper JS, Zuidersma M, Oude Voshaar RC et al. (2015). Social relationships and risk of dementia: A systematic review and meta-analysis of longitudinal cohort studies. Ageing Res Rev 22, 39-57.

8. Albanese E, Launer LJ, Egger M et al. (2017). Body mass index in midlife and dementia: Systematic review and meta-regression analysis of 589,649 men and women followed in longitudinal studies. Alzheimers Dement (Amst) 8, 165-178.

9. J Alzheimers Dis. 2014;42(1):119-35. Modifiable lifestyle factors in dementia: a systematic review of longitudinal observational cohort studies. Luigi Yuri Di Marco et al.