Professor Parveen Kumar, BMA board of science chair, talks about the board’s recent work on ageing and health, and why we must all challenge ourselves, as doctors, to think about the ways in which we can support healthy ageing.
What does healthy ageing mean to you?
For me, healthy ageing is not just the absence of disease. We must support the ability and opportunity for people to play an active role in society and shape their own lives as they grow older. Whilst people’s health is clearly vital in enabling this, it is more than just maintaining physical function. We must also be looking to promote the ability for individuals to continue to participate socially, economically and culturally, and work to reduce isolation among older people.
How should we respond to an ageing population?
For a doctor increases in life expectancy are clearly a cause for celebration, yet too many people still spend these extra years of life in poor health. We need to adapt to meet the changing health needs of the older population, who are more likely to suffer from multiple long-term conditions.
In doing this it is important older people are not seen as a ‘burden’, or viewed as a ‘passive’ group consuming finite resources. Too often we fail to recognise the important economic and social contributions that older people continue to make. Older people are often written off as a ‘problem’ rather than an ‘opportunity’ of what they can provide from their vast experience and maturity.
What role can doctors play?
Patient-centred care must be promoted. We need to ask what matters most to our patient? This is a move away from the traditional focus on single conditions, or single diseases, and takes into account people’s needs as a whole. To support this we should better value multidisciplinary working – which is vital for treating patients with multiple long term conditions and ensuring services meet the requirements of older individuals. Identification and support of those caring for older people is also essential.
We also need to bear in mind the way in which negative perceptions of ageing can impact on individuals as they age, and avoid perpetuating negative stereotypes of older people.
What is the BMA doing?
The board of science’s briefing papers on Growing older in the UK explore a range of topics relevant to supporting and improving people’s health and wellbeing as they grow older, including actions that individual doctors can take. My hope is that these will serve as a foundation for the BMA and others to pursue further work, and that importantly, they will help with the development of a wider focus on supporting the health of us all as we age.
We want to hear your thoughts
What barriers do you experience in the treatment of older patients with multiple long-term conditions? How are you overcoming these?
How do you identify and support those caring for older patients?
What impact does loneliness and isolation have on the health of your patients? How can this be overcome?
Rob Wilson is a senior policy advisor in the science and public health policy team
The BMA Board of Science, BMJ and BMA News might wish to consider the following ten facts which I witnessed as medical doctor in London for 53 Years (1964 to 2017) and now being a Life Member of the BMA, at age 81yesrs:
1. Elderly patients include doctors and politicians; they all need appropriate care. We should accept this fact which I have seen as being ignored.
2. It applies to all organs of the body, especially the brain; if you use it you do not lose it. Please continue till you are unable to use.
3. The distinction and discrimination are based on genetics, environment, age, gender, social class. culture, religion or non-
religious beliefs, race, education and opportunities. I have seen my colleagues denying this fact, in parts as it suits them. Let us accept that we cannot eliminate discrimination and install distinction totally but we can deal with these factors practically
especially when dealing with the elderly.
4. Sometimes, it is better to be lonely in old age than being in bad company or money seeker carers / do gooders. Everything is relative, especially good and bad.
5. Euthanasia for the elderly patients is a hidden British custom; In 1964, as a House man in London;
A. I noted notices on bedside of some elderly patients in many hospital saying "NTR" (Not to Resuscitate.).
B. I prescribed Penbritin (antibiotic) to a 70 years old English woman in a medical ward. The ward sister told the Consultant
who told me off on next day round. I agreed with him as I needed a testimonial to get a next job but I prescribed
antibiotics when needed, justified in notes legally.
C. Sometimes, Patient's next of kins declined or agreed with a houseman not to resuscitate or prescribe antibiotics.
D. From 2016, the computer puts pressure, in English ways, not to prescribe antibiotics, ibuprofen, paracetamol, bonjela and so on.
6. Only in Britain, I observed that Academics and Politicians hate each other, often behind the scene. They may deny it. What can we do?
7. Politicians are using "Patients Power" with "CQC inspections" to close hospital and Revalidations to reduce doctors, to save money but not patients. What Americans do openly (e.g. Donald Trump) the British do in cognition, we cannot stop them, both are right, let us be honest.
8. Elderly patients, even doctors, seek private prescriptions and treatment to survive longer. They are lucky ones.
9. In 1969, we GPs used to do home visits to old people to reduce loneliness. On my one visit, an elderly English woman asked me to treat her here at her home and not to send her to the local hospital. She did live long, no surprise.
10. Birds of a feather flock together. There is a natural segregation in Britain in caring for the elderly patients. Beware, if you wish to live longer. Help yourself. Even God help those who help themselves.
Dr Bashir Qureshi FRCGP, FRCPCH, AFOM-RCP, Hon FFSRH-RCOG, Hon MAPHA-USA, Hon FRSPH.
Life Fellow of the BMA. Now, 81 years old but young at heart.
It is difficult to manage pain in the older person due to limited resources and lack of pharmaceutical industry interest in developing analgesic agents specific for this age group.
The whole idea of MMC seems to be creating powerful managers and weak doctors. Do you agree ?
It seems to me that we should have the legal right to die. Death is inevitable but "how" and "when" are the two questions that remain to be answered - I would like there to be a legal right to make these decisions and to fulfill them here in England.
It is well established that physical activity increases mitochondrial content. (see attachment) Other studies demonstrated that continuously working muscles, such as the heart, had more mitochondrial activity and content than sporadically functioning muscles, such as back muscles.
So we need to get cold occasionally and use our muscles to maintain fit mitochondria (originally cell ingested microbes ) and to stop apoptosis (cell death.) Care, central heating, not going outside being inactive- counterintuitively - treduce life expectancy though they increase immediate physical safety at the total body level - Children are directed unwittingly to sit down, keep warm and to be physically inactive travelling in motor cars.
We will do some exercise at the public conference and walk to Glossop station to see the results of some excellent social capital and discuss the roles of mitochondria in diabetes, metabolic syndrome, renal failure, osteoporosis, ageing, dying dementia and death etc.
"Complex cells (such as human cells) did not evolve by standard and natural selection , Margulis argued, but in an orgy of cooperation, in which cells engaged with each other so closely that that they even got inside each other. Symbiosis is a long term interaction between two or more species, usually some sort of trade for wares or services. In the case of microbes, those wares are the substance of life, the substrates of metabolism, which power the lives of cells. . Margulis talked about endosymbiosis (endo - inside) - the same types of trade, but now so intimate that some collaborating cells physically live inside their host cells like th traders that sold from within the temple." (Nick Lane "The vital question)
Mitochondria in cell death - the mitochondria have a central role in cell death, health and function.
Mitochondria are direct descendants of an α-protobacteria endosymbiont 2.7 billion years ago. Owing to their bacterial origin, mitochondria have their own genome and can autoreplicate. Mitochondrial proteins are encoded by the nuclear and the mitochondrial genomes.
Mitochondrial biogenesis can be defined as the growth and division of pre-existing mitochondria. Mitochondrial biogenesis is influenced by environmental stress such as exercise, caloric restriction, low temperature, oxidative stress, cell division and renewal and differentiation. Mitochondrial biogenesis is accompanied not only by variations in number, but also in size and mass.
Mitochondrial biogenesis and endurance exercise
It is well established that physical activity increases mitochondrial content. Other studies demonstrated that continuously working muscles, such as the heart, had more mitochondrial activity and content than sporadically functioning muscles, such as back muscles.
So we need to get cold occasionally and use our muscles to maintain fit mitochondria (originally cell ingested microbes) and to stop apoptosis (cell death.). Cars, central heating, not going outside being inactive- counterintuitively - though they increase physical safety at the total body level - reduce life expectancy.