Development of interventions to enhance health and wellbeing in later life (The LIVEWELL programme)

Lead Research Organisation: Newcastle University
Department Name: Institute for Ageing and Health

Abstract

Although we are living longer than in previous generations, in many cases the greater number of life years includes more years of chronic poor health so that much of humankind?s experience of ill-health and expenditure on medical and social care (especially in Western countries) are concentrated in the later years of life. The challenge is to finds ways of improving health and maintaining wellbeing throughout the life-course.

There is very good evidence that behavioural factors (smoking, diet, alcohol consumption, physical activity) and social conditions are strongly associated with health and wellbeing in later life. However, there is very little evidence about practical interventions to change these factors that are effective in promoting improved health and wellbeing in later life. The LIVEWELL programme is designed to address this research gap by identifying i) types of intervention that are expected to be feasible, effective, and cost effective i.e. behavioural and social changes that can be incorporated into everyday life and ii) windows of opportunity when interventions are likely to be most effective. In addition we will develop tools for measuring change in health and wellbeing in response to interventions ? lack of such tools is a significant limitation on current research attempting to improving health and wellbeing in later life.

We plan to focus on the ?retirement window? i.e. the period before and after when the main income provider in a household retires from primary employment. In discussion with older people about what they think would be feasible and attractive and on the basis of the best research evidence available, we will develop interventions will address each of the main behavioural and social factors which are likely to be modifiable. This will include novel interventions in the areas of diet (encouraging a Mediterranean eating pattern), physical activity (e.g. walking and swimming) and social interactions. We will integrate these new interventions with more established interventions on smoking cessation and moderation in alcohol consumption to develop a package of interventions which, when appropriate, can be tailored to the needs of individuals and communities. Further, we will develop novel ways of delivering these interventions which will be feasible and cost-effective and which will encourage sustained behaviour change and improved social circumstances in preparation for later studies to test the intervention package.

Technical Summary

The dramatic increase in human longevity has been accompanied by an increasing burden of frailty and of chronic poor health. Much of humankind?s experience of ill-health and expenditure on medical and social care (especially in Western countries) are concentrated in the later years of life. The challenge is to find ways of improving health and maintaining wellbeing throughout the life-course.

In contrast with the wealth of observational data supporting the hypothesis that health and wellbeing in later life are influenced strongly by behavioural factors and social conditions, there is a dearth of evidence about interventions that are effective in promoting improved health and wellbeing. Prerequisites for the development of such interventions include identification of i) intervention modalities that will be effective, culturally appropriate and cost effective; ii) windows of opportunity when interventions are likely to be most effective; and iii) outcomes measures responsive to the interventions that can measure change in health and wellbeing. The LIVEWELL programme will fill this research gap by addressing these prerequisites for interventions. Based on the MRC framework for development and evaluation of complex interventions, we will identify types of intervention that are expected to be feasible, effective, and cost effective i.e. behavioural and social changes that will be attractive to older people. The lack of outcome measures which capture the healthy ageing phenotype, as distinct from measuring disability or ill-health, is a significant impediment to the evaluation of interventions. We will develop tools for this purpose.

We will focus on the ?retirement window? i.e. the period before and after the main income provider in a household retires from primary employment. In discussion with older people, and based on both rigorous systematic reviews of the literature and behaviour change theory, we will develop interventions to address each of the main modifiable behavioural and social factors. This will include novel interventions in the areas of diet (encouraging a Mediterranean eating pattern), physical activity (e.g. walking and swimming) and social interactions. We will integrate these new interventions with more established interventions on smoking cessation and moderate alcohol consumption to develop a package of interventions which, when appropriate, can be tailored to the needs of individuals and communities. Further, we will develop novel ways of delivering these interventions which will be feasible and cost-effective and which will encourage sustained behaviour change and improved social circumstances in preparation for later studies to test the intervention package.

Publications

10 25 50

 
Description A Strategy for Collaborative Ageing Research in the UK
Geographic Reach National 
Policy Influence Type Influenced training of practitioners or researchers
 
Description LiveWell Director - Postgraduate teaching masters of research
Geographic Reach National 
Policy Influence Type Influenced training of practitioners or researchers
 
Description MRC Nutrition and Health Review Workshop, 7th - 8th July 2016
Geographic Reach National 
Policy Influence Type Participation in a advisory committee
 
Description MRC Review of Nutrition and Human Health Research, 14 Oct 2016
Geographic Reach National 
Policy Influence Type Participation in a advisory committee
 
Description MRC Review of Nutrition and Human Health research - 17th March
Geographic Reach National 
Policy Influence Type Participation in a advisory committee
 
Description Award from the MRC - Arthritis Research UK Centre for Musculoskeletal Ageing Research
Amount £625,000 (GBP)
Organisation Versus Arthritis 
Start 09/2011 
End 12/2016
 
Description Award from the MRC - Arthritis Research UK Centre for Musculoskeletal Ageing Research
Amount £1,875,000 (GBP)
Organisation Medical Research Council (MRC) 
Sector Academic/University
Country United Kingdom
Start 09/2011 
End 12/2016
 
Description MRC LLHW (Phase 3) Guidelines on Biomarkers of Healthy Ageing
Amount £50,000 (GBP)
Organisation Medical Research Council (MRC) 
Sector Academic/University
Country United Kingdom
Start  
 
Description Prevention and Risk Reduction
Amount £750,000 (GBP)
Organisation Alzheimer's Research UK 
Sector Charity/Non Profit
Country United Kingdom
Start 08/2017 
End 07/2020
 
Title Blood-borne biomarkers of mortality: a systematic review of cohort studies by a LiveWell PhD Student 
Description This systematic review was registered on Prospero - the international prospective register of systematic reviews. The aim of this review is to conduct an exploratory search to identify blood-borne biomarkers of mortality which could be used as outcome measures for health and wellbeing interventions delivered in the peri-retirement window. 
Type Of Material Data analysis technique 
Year Produced 2011 
Provided To Others? Yes  
Impact None as yet 
 
Title LLHW inititative to identify synergies and improved research infrastructures. 
Description The LiveWell team have had discussions with other funders through the LLHW initiative to identify synergies and improved research infrastructures. As a consequence, all 3 LiveWell Programme M.Res/PhD students participated in the Research Retreat on 4-6 November 2010 organised by the LLHW-funded Centre for Brain Ageing and Vitality. 
Type Of Material Improvements to research infrastructure 
Year Produced 2010 
Provided To Others? Yes  
Impact Information still to be received 
 
Title Lifelong Health & Wellbeing Centres and Programmes - Innovations for Lifelong Wellbeing Conference 2011 
Description The LiveWell Director and 4 RAs shared their research materials and methods and delivered the following 4 presentations:- 1. 'The Mediterranean diet: the diet systematic review' 2. 'Identifying and understanding features of behaviour change interventions'. 3. 'a qualitative investigation of health and wellbeing through the retirement transition'. 4. 'Promoting physical activity in the community: a systematic review' 
Type Of Material Improvements to research infrastructure 
Year Produced 2011 
Provided To Others? Yes  
Impact impact to the LiveWell project specifically 
 
Title Lifelong Health & Wellbeing Research Retreat 2010 
Description LiveWell's 3 PhD students each did presentations on 1. 'Dietary patterns as predictors of childhood adiposity'. 2. 'Physical activity in the retirement window: A theory based interview study' 3. 'Blood-borne biomarkers of mortality: a systematic literature review of cohort studies'. 
Type Of Material Improvements to research infrastructure 
Year Produced 2010 
Provided To Others? Yes  
Impact Shared research materials 
 
Title Mediterranean Diet Systematic Review 
Description Dietary Systematic review on "Effectiveness of interventions promoting a Mediterranean diet, or any combination of its component food groups, on changing diet behaviour during the retirement transition: a systematic review and meta-analysis of randomised controlled trials. 
Type Of Material Data analysis technique 
Provided To Others? No  
Impact n/a 
 
Title Systematic Review of the long term effects of physical activity for older adults 
Description Registered with Prospero databases, this systematic review looks at the maintenance effects of physical activity randomised controlled trials in healthy and 'at risk' older adults. Long term effectiveness of physical activity interventions in the retirement transition: systematic review and meta-analyis. 
Type Of Material Data analysis technique 
Year Produced 2011 
Provided To Others? Yes  
Impact Not known 
 
Title XCAR Early Career Researchers Conference 
Description XCAR Early Career Researchers Conference - PhD Students and Post docs attended from the LLHW funded centres. LiveWell RAs and PhD students attended and presented the following:- Abstract on 'Novel approach to assess postural control in Parkinson's disease during gait'. Discussed the research methods used, data collected and the analysis results. Oral poster presentation on - 'Dietary patterns: responses to lifestyle interventions in the peri-retirement window'. Oral poster presentation on - 'blood-borne biomarkers of mortality'. 
Type Of Material Improvements to research infrastructure 
Year Produced 2012 
Provided To Others? Yes  
Impact On going research materials 
 
Description Proposal for development of MRC Guidelines on Biomarkers of Healthy Ageing 
Organisation Medical Research Council (MRC)
Department MRC National Institute for Medical Research (NIMR)
Country United Kingdom 
Sector Public 
PI Contribution The LiveWell Director and members of the team have developed a workplan to encorporate 4 other PIs from 4 collaborative Universities to do a 12 month preparatory review of the evidence on (bio) markers of healthy ageing leading to a summary of the state-of-the-art draft Guidelines.
Collaborator Contribution Our partners have made a huge contribution to the preparatory work and will aid in the writing of the draft Guidelines which will be submitted to the MRC for a high visibility peer-reviewed journal.
Impact A 2 day Biomarkers of Healthy Ageing Workshop to which International, European and UK wide experts attended.
Start Year 2011
 
Description 7th NICIS conference, Insitut Pasteur, Paris. June 2017 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Inter-disciplinary discussion exchanging learning from several diverse fields.
Year(s) Of Engagement Activity 2017
URL https://healthmanagement.org/c/icu/event/nicis-neurosciences-in-intensive-care-international-symposi...
 
Description Do you want to know more about Dementia? for the Alzheimers society 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? Yes
Geographic Reach Regional
Primary Audience Public/other audiences
Results and Impact the Director of LiveWell did a presentation on "The LiveWell Programme: Developing interventions for healthy ageing" and the Neuropsychologist (RA) presented on "A healthy brain across the lifespan. A good question and answer session resulted.

Further collaboration may arise in the future
Year(s) Of Engagement Activity 2011
 
Description Dutch Nutritional Science Days, The Netherlands. October 2017 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Postgraduate students
Results and Impact Discussion of the opportunities and challenges of personalised nutrition and potehtial as strategy for improving public health
Year(s) Of Engagement Activity 2017
URL https://www.voedingsacademie.nl/nutritional-science-days/
 
Description Dutch Society for Research on Ageing conference, Lieden, Netherlands. May 2017 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Preseantation of findings from ongoing research on personalised nutrition and opportunities for application to improve healthy ageing
Year(s) Of Engagement Activity 2017
URL http://www.nvvvo.nl/nvvvo.nl/?lang=en
 
Description Food and Drink Federation, Nutrition Committee London 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? Yes
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact The Director and Principal Investigator was an invited speaker at the Food and Drink Federation, Nutrition Committee meeting where members of the general public were invited to hear him talk about "Nutrition and Healthy Ageing". A positive discussion followed

Further collaboration expected
Year(s) Of Engagement Activity 2011
 
Description Healthy Ageing Phenotype Workshop 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? Yes
Type Of Presentation Keynote/Invited Speaker
Geographic Reach International
Primary Audience Other academic audiences (collaborators, peers etc.)
Results and Impact 55 invited speakers/guests attended the Workshop on the Healthy Ageing Phenotype (HAP). The HAP is an holistic concept which attempts to encapsulate the ability to be socially engaged, productive and to function independently both at a physical and cognitive level. However, as yet, there is no agreed definition of the HAP and no consensus on how it should be measured.

Assesment of the HAP will be particularly useful in longitudinal studies and in intervention studies to promote health in later life such as the LiveWell programme. The aims of this Workshop were to produce a pragmatic definition of the HAP and to identify a minimum set of standardized measures to assess the different components which characterise the HAP. Our focus is on outcome measures in community-based, lifestyle intervention studies. Such measures of the HAP may have wider utility and could facilitate comparisons across diverse study designs and populations. A Delphi Survey has been run to rank a list of domains of the HAP in order of importance, to identify any domains that should be excluded and to suggest further domains which should be considered for inclusion.
Year(s) Of Engagement Activity 2012
 
Description IFST Spring Conference, April 2017 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Discussion with industry colleagues about opportnities for personalised nutrition
Year(s) Of Engagement Activity 2017
URL https://www.ifst.org/civicrm/event/info?reset=1&id=566
 
Description International Sport and Exercise Nutrition Conference. Newcastle upon Tyne. Dec 2017 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact More than 200 academics and practitioners attended the conference. In addition to the formal question and answer session at the end of my presentation, this was followed up by informal discussions about related research with colleagues from other universities.
Year(s) Of Engagement Activity 2017
URL http://www.isenc.org/
 
Description KTN Chemistry & Industrial Biotechnology Showcase 2017, University of York. Sept 2017 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Presentations of outcomes from LiveWell Programme of research on healthy ageing
Year(s) Of Engagement Activity 2017
URL http://ib-showcase2017.meeting-mojo.com/
 
Description LiveWell - Qualitative Work Package 1 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Type Of Presentation Workshop Facilitator
Geographic Reach Local
Primary Audience Public/other audiences
Results and Impact This qualitative study was conducted to explore older people's views on health and wellbeing in retirement: specifically their views on physical activity, dietary patterns (food) and psychosocial factors including transition to retirement and their views on the desirability and acceptability of intervening in this period. Our Social Scientist RA conduted 4 focus group sessions and 4 semi-structured interviews involving 6-8 participants lasting 60-90 minutes. Those involved were from the local ageing community and local businesses and it included a range of employees, those recently retired and members of staff from HR.

The output and notable impact that arose from this activity has formed the basis of a report to be used within the LiveWell programme to inform the development of interventions for people in peri-retirement and as one or several academic papers for peer-review and external dissemination.
Year(s) Of Engagement Activity 2012
 
Description LiveWell Dissemination Event on 9th November 2010 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Health professionals
Results and Impact The event was attended by 146 guests from a wide cross section of organisations, e.g. Public Health, Local and Regional Government, Charities, NHS, Local Businesses, Age Related organisations, Academics, Regional Press and retired members of the public. The event was a great success and we have received very positive feedback. The event programme started with an introduction to the LiveWell Project by Professor Mathers, followed by a Mediterranean cookery demonstration. The guests then had an opportunity to listen to presentations by the LiveWell teams, take part in demonstrations and activities (using state-of-the-art equipment) to gather information about the four key research areas of the project - Physical activity, Mental Wellbeing, Social & Personal Wellbeing and Nutrition (focussing on the benefits of a Mediterranean diet). Guests were able to sample a range of Mediterranean food. Guests were able to ask questions to the team and were supplied with further information in the delegate pack.

Over half of the guests completed an evaluation questionnaire and the notable feedback and impact the event had on them was as follows: The majority felt that the event was interesting, thought-provoking, that there was a good balance of activities, they felt that they had learnt something and that they had a clear understanding of the aims of the LiveWell Project. As a result we feel that there will be further opportunities to collaborate with some of these organisations throughout the duration of the project, as we discovered that there is a huge amount of interest in healthy ageing. We were generously support by several local food suppliers who are keen to be associated with the project and donated food for the event. The Newcastle Chronicle & Journal published an article on the event and Tyne Tees Television recorded various activities and interviewed key people which was broadcast on the regional news broadcast.
Year(s) Of Engagement Activity 2010
 
Description LiveWell co-design Workshop 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Type Of Presentation Workshop Facilitator
Geographic Reach Regional
Primary Audience Participants in your research and patient groups
Results and Impact This Workshop on the design of lifestyle based interventions included 22 peri-retirement aged volunteers together with employers, representatives from the NHS health improvement specialists and Age UK and quality of life partnerships. The facilitators were members of the LiveWell team. The overall aim of the Workshop was to generate ideas for (internet-based) lifestyle services to support people in the retirement transition period to be more active, to eat well and to feel personally fulfilled through activities or being part of a community. Guests were split into 6 groups and discussion was focused around a "personna" who illustrated different experiences of the retirement transition.

The outcomes of the 6 group sessions during the Workshop, together with the final plenary session has been extremely valuable in generating ideas for intervention development. The feedback will be analysed and will form an important part of the intervention design process. The interventions that are developed as a result, will be assessed for their effectiveness and their acceptability to users, deliverers and potential purchasers.
Year(s) Of Engagement Activity 2012
 
Description Public Lecture by LiveWell Principal Investigator 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? Yes
Geographic Reach Regional
Primary Audience Public/other audiences
Results and Impact The audience was made up of middle aged and older people no longer in full time employment interested in research and lifelong education.

possible further lectures on similarly related topics
Year(s) Of Engagement Activity 2011
 
Description Surrey University - contribution to Masters degree on Nutrition and Ageing. July 2017 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Postgraduate students
Results and Impact Lecture to students on part-time Masters course. Lots of discuussion about implications for personal research and practice.
Year(s) Of Engagement Activity 2017
URL https://www.surrey.ac.uk/postgraduate/nutritional-medicine-msc-2018
 
Description Translational Aging Research: Challenges and Opportunities, Lorentz Centre workshop, Amsterdam 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Contributed to development of strategy for research in ageing in The Netherlands
Year(s) Of Engagement Activity 2016
 
Description Workshop on Guidelines for (Bio) markers of Healthy Ageing 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? Yes
Type Of Presentation Keynote/Invited Speaker
Geographic Reach International
Primary Audience Other academic audiences (collaborators, peers etc.)
Results and Impact 55 academic experts attended a 2 day Workshop on the development of Guidelines for (bio) markers of healthy ageing to hear invited speakers presenting key topics and to be involved in group discussions. There is an enormous diversity in types of measurement proposed by researchers as markers of healthy ageing. This diversity reflects both the difficulty of characterising and measuring the (complex) phenotype of healthy ageing and the lack of robust, validated tools for assessing healthy ageing. Bio markers of healthy ageing means very different things to different people and the absence of agreed/accepted markers is a limitation on scientific progress. To move the research area forward, it was agreed that we should produce a set of Guidelines for (Bio) markers of Healthy Ageing along the lines of the MRC Guidelines on "Developing and evaluating complex interventions".

The impact from the expert presentations and the presentations critiquing the proposed guidelines - provided the Steering Group with extremely valuable data, feedback and material for LiveWell and all invitees. This information will form the basis of a set of Guidelines which will be submitted to the MRC which will shape future research on robust and validated tools for assessing healthy ageing. The proposed Guidelines are expected to be wide reaching in its overall impact and to be useful not only for the research community but also for national and local health surveys and for commercial organisations.
Year(s) Of Engagement Activity 2012