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On Tuesday January 27^th 2015, Maarten Wensink will publicly defend his thesis ‘The Evolution of Ageing: Concepts, Causation and Calculus’ in the Academy building in Leiden.

During his medical education, Maarten became interested in the conceptual foundations of the evolutionary theory of aging, and in the mathematics that pertain to these concepts. Maarten is currently a PhD student at the Max Planck Institute for Demographic Research (MPIDR), Rostock, Germany, under joint supervision of Annette Baudisch (MPIDR) and Rudi Westendorp who was director of Leyden Academy on Vitality and Ageing until 1 January 2015 and now serves as Professor of Medicine at Old Age at the University of Copenhagen.

While evolutionary theories of ageing focus on the force of natural selection, relatively little thought has been given on the physiological possibilities and constraints different forms of life may or may not have. The interaction between these two factors gives a promising new perspective on the evolution of ageing.

The notion that ageing should have an evolutionary basis is over a hundred years old. Yet, it appears that several dissimilar ideas exist about what this evolutionary basis consists of, while not all of these ideas are airtight. In his thesis, Maarten evaluates current theories about the evolutionary basis of ageing, and develops new ideas. This is done by means of thought experiments, mathematical models and data analysis, in which medical and epidemiological thinking is an important element. A direction for further research is proposed.

We wish Maarten the best of luck in defending his dissertation and in his academic career, and above all a long, happy and healthy life!

 

After the death of a spouse, health care expenditure levels rise by almost half, according to research by Herbert Rolden, PhD student at Leyden Academy on Vitality and Ageing. The research Changes in health care expenditure after the loss of a spouse: Data on 6,487 older widows and widowers in the Netherlands provides insight into the economic value that spousal informal care represents in the Netherlands.

Elderly married couples take care of each other as their health gradually starts to fail. To understand the economic value of this type of informal care, Rolden investigated the health care expenditure through time for 6.487 Dutch widows and widowers aged 65 and older over the period from July 2007 until the end of 2010, in up to 42 months before and after the death of the spouse. After the loss of the spouse, monthly health care expenditure for the widow or widower rose on average by EUR 239 per month (+48%). Overall, the rise sets in at the month someone becomes widowed, and is highest for men (EUR 319; +59%) and widows and widowers aged 80 and older (EUR 553; +82%). Bereavement plays a minor role in the association between widowhood and health care expenditure. Herbert Rolden: "We see no peak in expenditure in the months directly after the death of the spouse. Also, the increase in health care expenditure is five times higher in the long-term care sector than the medical care sector. This suggests that expenditure levels predominantly rise because there is a higher need for formal care after the loss of an informal care-giver, rather than a higher need for medical treatment related to the health impact of bereavement and sorrow."

Economic value of informal care
In view of the increasing number of senior citizens in the Netherlands, it is important to better understand health care expenditure and the economic value of spousal informal care. This can be estimated by observing the difference in health care expenditure by people with a spouse with that of people who have no spouse, or no longer have a spouse. Rolden: "By offering informal care, people keep their partners, family members, friends or neighbours away from the health care sector. The most common type of informal care is from spouse to spouse, particularly wives taking care of their husbands. Since this type of caregiving is unpaid, it is rarely included in economic health care analysis. We have therefore investigated the impact of the death of the spouse on health care expenditure through time. We collected figures of individual health care expenditure within a large population over a long period of time from the database of a Dutch health care insurer, and linked this information with data on marital status."

Intervention programmes
Insight into the economic value of formal care prevention by spouses is important for policy-makers who are concerned with improving the lives of older people and who are, at the same time, obliged to curtail ever rising levels of health care expenditure. According to Rolden, intervention programmes including information, support, therapy, and respite care for older people providing intensive care for their spouses could have financial merit besides any potential beneficial effects on well-being.

The research ‘Changes in health care expenditure after the loss of a spouse: Data on 6,487 older widows and widowers in the Netherlands’ by Herbert J.A. Rolden, David van Bodegom and Rudi G.J. Westendorp has been published in international, peer-reviewd publication PLOS ONE on Tuesday 23 December 2014: http://dx.plos.org/10.1371/journal.pone.0115478.

In December 2014 it was announced that the consortium InnoLIFE receives a EUR 2.1 billion grant from the European Institute of Innovation and Technology. Within the InnoLIFE consortium 144 partners of leading businesses, research centres and universities from 14 EU countries have joined forces, including Medical Delta. With the grant, further research is financed into healthy living and active ageing. As a partner of Medical Delta, Leyden Academy on Vitality and Ageing expects to make an important contribution to the research and innovations that will be developed within InnoLIFE. The activities are expected to start in mid-2015.

For more information, visit the Medical Delta website: http://www.medicaldelta.nl/2014/12/10/eit-awards.

 

Today, during the symposium The Longevity Revolution, it was announced that Joris Slaets, Professor of Geriatric Medicine at University Medical Center Groningen, will join the Board of Directors of Leyden Academy on Vitality and Ageing. As of January 2015 he will succeed Professor Rudi Westendorp, who has accepted a position as Professor of Medicine of Old Age at the University of Copenhagen.

Since 1999, Joris Slaets is Professor of Geriatric Medicine at UMC Groningen and Head of the University Centre for Geriatric Medicine. He received a medical degree in Leuven, Belgium and was trained as a geriatrician at Erasmus University in Rotterdam. Professor Slaets is a coordinator in the National Care for the Elderly Program in The Netherlands and scientific advisor at Espria. Joris Slaets: “I have been closely involved with Leyden Academy for many years now, contributing to the Master programme and Executive courses. I have the utmost respect for what Rudi Westendorp, Marieke van der Waal and their team have established. Their mission, to improve the quality of life for the elderly, is very near to my heart. I want to encourage the outstanding research activities and projects at Leyden Academy and strive to make even more impact on society. There are so many opportunities.”

As of January 1st, Rudi Westendorp will start as Professor of Medicine of Old Age at the Health and Medical Sciences Faculty of the University of Copenhagen. He therefore takes leave as Professor of Geriatric Medicine at the Leiden University Medical Center (since 2000) and as executive director of Leyden Academy on Vitality and Ageing (since its establishment in 2008). Rudi Westerdorp: “For my wife and myself, this is an exciting new step in the second phase of our lives. I really look forward to taking the ideas and mental legacy of Leyden Academy to an international level. I am leaving Leiden in high spirits: I am proud of what we have achieved and also know there is still much to be done. Joris shares the optimistic view of Leyden Academy and brings a wealth of knowledge and expertise. I could not have hoped for a better successor.”

Dr. Wim van den Goorbergh, chairman of the Supervisory Board: “We are honoured to have Joris Slaets joining the Board of Directors of Leyden Academy. With his experience, perspective and network he makes the ideal candidate to further shape Leyden Academy in the years to come, together with director Marieke van der Waal. We would like to express our gratitude to Rudi Westendorp for the huge contribution he has made to a more positive public perception regarding older people in The Netherlands and we wish him all the best in achieving his goals in Denmark.”

Professor Rudi Westendorp was part of the trade delegation that accompanied the Dutch Royal couple from 27 to 31 October on their State visit to Japan. On Thursday 30 October he gave to King Willem Alexander and Queen Maxima and other invited guests a short presentation about vitality and Aging (see below).

Dear majesties, excellences, guests,

We appreciate an explosion of life.
Over the last hundred years, developing countries appreciate an ongoing increase of life expectancy.
Every decade citizens in our nations live 2-3 years longer.
Every week we get a weekend extra.
Few generations ago only one out of three reached age 65.
Nowadays retirement has become a certainty for almost all.
Only one out of ten dies before that age.
Longevity is not a disaster, it is un unprecedented success of mankind but poses our societies with unforeseen challenges.
It is an obligation to find solutions for this demographic revolution.
And that appears not to be impossible.

My home country has a tradition of studying families of which the members have the tendency to become long-lived.
They can ‘tell us’, ‘show us’ how to age successfully.
One of the lessons is that health is appreciated differently by medical professionals and elders themselves.
Professionals emphasize the physical functioning of brain and body.
As if it was a biological machine.
In the end we all become frail, but increasingly we are able to successfully delay that ageing process.
The nowadays 75 year olds are as healthy as our 65 year old grand parents.
However, older people emphasize that it is even more important what you do with your body, healthy or frail.
They tell us that we should follow our dreams and use our talents.
People do not feel good when being bored or lethargic and this is age independent.
For example, quite some healthy youngsters suffer apathy, ‘do nothing’.
Vitality is the inverse quality, it is a mental function.
People who are energetic and resilient can cope with the losses that life will bring.
They feel healthy.

This broad definition of health has major consequences for all.
We often take care of frail older people who have lost the lust to live.
It is important but not sufficient to take a medical emphasis.
In the Netherlands we have developed a routine to include elders in decisions what to do and when to refrain from intervention.
We have learned to take older people seriously.
The same holds when developing new innovative products and services.
Elders warn us to give too much attention to just treating the diseases of old age.
We should prevent overtreatment and hospitalization.
Older people would rather stay at home to maintain independent and feel well even at the cost of a shorter life span.

I summarize the following key messages to address the ongoing demographic revolution:
1. Keep a broad perspective on life balancing the biological and the mental aspects of our functioning: finally we prioritize the quality above the quantity of life.
2. We should avoid institutionalization and in stead make it possible for people to live at their home as long as possible: this necessitates the development of a complete new suit of services and products.
3. In contrast to general opinion, growing older is a normal and valuable part of our lifespan: we should avoid age discrimination at all costs an enable elders to live and act in the middle of our societies.
4. Professionals as well as volunteers should help and interfere only when people appreciate barriers that they cannot overtake themselves in stead of us overtaking their lives: freedom in old age means that people are enabled to organize their own life.

Ageing of our societies is a multifaceted challenge that not only necessitates input of the medical disciplines but also the humanities, law and economics.
It should unite various regional stakeholders to come up with innovations that address the people’s needs and at the same time serve the society as a whole.
For example, in the south west of the Netherlands universities, hospitals, municipalities and private companies of Leiden, Delft and Rotterdam have joined forces to make that chance.
Here at Tokyo University the ‘Platinum’ network has been build, a similar collaborative action and impressive initiative to transform the out of date settlements in Kashiwa into vital communities.
This initiative showcases the ambition and the thought leadership that will successfully deal with the demographic change of our societies.
Before long we will all see that ageing of our societies is a virtue, not a disaster.

Let me finish by thanking you for listening and by wishing you a very successful old age.

Professor Rudi Westendorp

Background
The thesis of Frouke Engelaer entails research on the compression and plasticity of old-age mortality during the epidemiologic transition. Studying old-age mortality during the epidemiologic transition is of great importance now that an increasing number of people reach old-age.
Life expectancy has increased all over the world from an average life expectancy of approximately 40 years before the epidemiologic transition to an average life expectancy that exceeds 80 years in post transitional countries today. This major success in improving life expectancy was accompanied by a shift from child to old-age mortality and from infectious to non-infectious diseases. The process of these mortality changes are described in the epidemiologic and demographic transition theories.

 

Main findings
Overall, when countries shift from a pre- to a post-transitional stage, mortality decreases and an increasing number of people live up to old age. In addition, mortality is compressed to a narrower age interval in which most of the annual deaths occur. This compression of mortality reaches a limit as soon as countries enter the post-transitional era. Furthermore, during the last stage of the epidemiologic transition, with the appearance of ‘diseases of affluence’, we have observed an expansion of morbidity and more years are lived with chronic diseases. By contrast however, life expectancy without disability is increasing parallel to the increase in life expectancy indicating a compression of disability. Due to earlier diagnosis more years are lived with chronic diseases, but this allows for early treatment that in the end postpones or even prevents disability. In general, mortality remains highly plastic up to old age, as indicated by the continuous rise in life expectancy and the shift of the age-at-death distribution towards higher ages.

 

Implications for society
The plasticity of mortality as we have observed during the epidemiologic transition has resulted in a rising number of people that have the privilege to live up to old age while maintaining good health. However, this trend can only continue when we adapt our society to accommodate our growing population of elderly. This comes with several societal challenges in terms changes in formal and informal care, health care costs and pension policies. Some of the implications will be discussed below.

 

Dependency ratio
The epidemiologic transition has lead to both low fertility and low mortality, which has resulted in ageing populations, especially in today’s western societies. The age composition in these populations has changed from predominantly young individuals towards an age composition in which the proportion of children, adults and elderly is almost equal. This is one of the most common starting points for policy makers and is often measured as the dependency ratio. This ratio is an age-based indicator for the burden on the productive labour population and is given as the ratio of non-productive per productive individual. Based on the observations in our studies, however, we have several remarks concerning the dependency ratio as a measure for policy makers. First, while the old-age dependency ratio is increasing, one should not overlook that the total dependency ratio is influenced by the youth dependency ratio as well. The latter ratio (0-19 years divided by 20-64 years) has decreased during the last 50 years and will further decline in the future. The old-age dependency ratio (65+ divided by 20-64 years) has increased and is expected to do so in the coming decades. The total dependency ratio however, has not increased, and has in fact slightly decreased. A second reason dependency ratio’s are inaccurate is because it categorizes all people aged 65 years or older as dependent. As it is an indicator based solely on chronological age, it overlooks that not all individuals above age 65 are dependent. Especially as we have shown that with the shift of mortality to higher ages, life expectancy in good health and without disabilities also increases. Policy makers should take this into account when using the total dependency ratio as a starting point for future policies in formal and informal care, health care costs and pension systems.

 

Health care costs
The average level of long-term care expenditure has been shown to rise with age. It is questionable however, whether population ageing is the major driver of the ever increasing health care expenditure. For instance, it has been shown that health care cost are concentrated in the last year of life. This is in line with our findings of a fixed period of disability at the end of life that cannot be further compressed. This implies that irrespective of how old one gets, the disability burden and the highest health care costs will be in the last year of life. In addition, the demand for health care will be postponed to higher ages. All in all, although higher ages are known to be associated with higher long-term care expenditure, is not the main explanation for the rise in health care costs. Alternatively, there has been an expansion in the use of medical technology during the last decades. These technical innovations have fostered the rise in health care expenditures and hence have played a major role in the overall increase in health care costs.

 

Pension policies
We have shown that human lifespan is continuously on the rise. This plasticity not only results in longer lives for individuals, but also for more people reaching old age. This has several consequences for many countries that offer their older citizens financial security through pension systems. In a social pension system, financial resources are redistributed from the working population to the retired population. In other words, as the old-age dependency ratio increases, a smaller working population is responsible for a relatively larger retired population. This will become a major burden for pension systems. Although life expectancy and healthy life expectancy are still increasing, many countries still have a relatively early withdrawal from the labour market, at an average age below 60. Increasing pension age not only helps to reduce the burden for pension systems, but it also results in a larger labour force. Most countries however, are hesitant to take the necessary measures in order to achieve this. It is now time to act and make sustainable policies that meet the needs from ageing societies.

Conclusion
Overall, our studies show the plasticity of old-age mortality. There is no indication that we have reached the limits of this plasticity, which is an encouraging finding. Hence, we can be optimistic about the future, but we also have to adapt to the new reality that people live longer and more years are lived in good health.

 

Leyden Academy
Frouke Engelaer has been part of Leyden Academy on Vitality and Ageing since the foundation. In addition to conducting research at Leyden Academy, she successfully completed the Master Vitality and Ageing and was involved as student assessor.
The management and staff of Leyden Academy wish Frouke good luck in defending her dissertation on Wednesday 10 September, and a promising career, and above all a long, happy and healthy life!

17 September 2014: 
‘Healthy ageing with a paleolithic diet’

Contents of the public lecture
Our genes have been adapted to our environment, including our diet, through millions of years of evolution. Many, if not all, of the current diseases of civilisation result from the mismatch between our present environment and our paleolithic genome. Kuipers will address these differences and discuss the most important discrepancies between our present and our ancient diet.

Background dr. Remko Kuipers
Remko Kuipers is not only a doctor and pharmacist, but especially a researcher. He was the first Dutchman to obtain a doctorate in evolutionary medicine, the science thatengages in the relationship between evolution, lifestyle (including nutrition) and health. For his doctoral research he lived among the hunter-gatherers of Africa, Asia and Central America. Dr. Kuipers is the author of the successful book ‘Het oerdieet’, in which he explains why we should all eat like our ancestors.

Date and time
The lecture takes place on 17 September 2014 between 16.00-18.00 hours:
16.00 – Introduction dr. David van Bodegom Leyden Academy
16.10 – Lecture dr. Remko Kuipers
17.15 – Discussion
17.30 – Drinks

Location
Leyden Academy on Vitality and Ageing
Poortgebouw Leiden, Entrance ‘Zuid’, Room 0.15
Please click here for directions.

Register
Send an e-mail by 12 September to register for this free academic lecture: ageing@leydenacademy.nl 

 

In the second week of July, Leyden Academy on Vitality and Ageing and the LUMC Faculty of Social Sciences/Psychology organised the Honours class ‘Vitality matters’ for the first time. Around 20 high scoring students – with an average grade of 8 or higher – attended this intense course that was all targeted towards the question “What about vitality?”.

During the week of full day lectures and working groups, students concerned themselves with the diverse dimensions of vitality: What is it? How can we define it? What mechanisms underlie it? And how can we target vitality in practice? As students were from diverse disciplinary backgrounds the interaction resulted in an exchange of diverse ideas from psychology, medicine, law, international relations, biology and biomedical sciences.

At the end of the week students presented their interventions ranging from self-organized gardening, vitality coaches and a website/app by which older individuals can travel together. Finally, individual papers will be developed from this intense week and proposed interventions. It was an illuminating and inspiring week, shedding light on the concept of vitality and its possible contributions in the lives of older persons.