We hope our latest edition of Health Matters – this time covering midlife approaches to reduce dementia risk – will help you and other health professionals by compiling key facts, figures and evidence of effective interventions.
Where we can, we’re also committed to answering your questions and taking on your feedback. In this blog we’ve published the answers to a number of Health Matters dementia questions we received from professionals across the UK following the launch teleconference (podcast available here).
We’d love to hear from you at healthmatters@phe.gov.uk.
Question 1 (evidence that changing lifestyle has an effect)
What’s the evidence that changing your lifestyle in midlife will actually reduce your chances of developing dementia?
Answer: This is really good question because it is at the heart of what we are trying to achieve, and part of the reason we started on the journey with the Blackfriars Consensus in 2014 was to start the process of actually gathering that evidence.
The real step change came in October 2015 when NICE issued their guideline on mid-life approaches to delay or prevent the onset of dementia, disability and frailty in later life. Their guidance talks about the importance of introducing messaging around behavioural change in earlier life rather than waiting until later in life. This sounds pretty self-evident but NICE went through all the evidence that was available at that time before it determined that there was a sufficient body of evidence to pursue this aim.
Question 2 (sustainability of behaviour change)
There is good quality evidence in the literature of interventions that can be delivered in midlife to change these behaviours in midlife. How do we get the barriers out of the way to enable people to change their behaviours in the long term?
Answer: This is the nub of the question – sustainability of behavioural change, especially if it starts earlier.
The introduction of risk factors as a concept in the NHS Health Check and our piloting different ways of approaching this, will give us an opportunity to deliver a process that may be able to give us the evidence that we require to answer the question.
At Public Health England we are dedicated to looking at improving health across the life course as it’s a lot easier if we can encourage people to adopt health behaviours early and to maintain them.
We are doing a lot of work in the digital space as more individuals are becoming more knowledgeable about using the internet and digital tools that can be personalised approaches that quantify activity or eating habits.
We are also looking at opportunities in social marketing to ensure that we are making changes in the social and structural environment. What we can do with families, what we can do with communities to ensure that we are promoting and supporting the behaviour change.
The recently introduced One You campaign is about the changes that a person can make in seven areas (eating well; drinking less alcohol; quitting smoking; being more active; sleeping well; stressing less and checking yourself).
At the individual level, we are ensuring that the changed behaviours that we are trying to promote and support are fun, easy and accessible. We want to encourage everyone to make easy and simple choices in their behaviours to improve their health.
For example we use a lot of behavioural insights to think about ways in which we can support all individuals to become more physically active.
Question 3 (public perception of the risks)
In a YouGov survey commissioned by Alzheimer’s Research UK, only 25% of British adults said they thought it was possible for people to reduce their risk of developing dementia, compared to 83% for diabetes and 82% for heart disease. So haven’t we got an awfully long way to go before people make the link between improving our lifestyle and reducing dementia?
Answer: We are now having a conversation about dementia that we never used to have. It is a relatively recent phenomenon that people are willing to talk about dementia and that we can bring some proper science to bear that says actually the risk factors are the same, whether they’re for heart disease, diabetes or dementia.
It’s quite extraordinary how pretty much everybody is talking about the risk factors for dementia as if we’ve always known and understood that eating well and not smoking and drinking can potentially reduce prevalence of dementia.
It is going to take time but it’s a good place to be because we can all talk to the public in an adult way about these risks. We’ve just got to keep at it until we close that gap in understanding.
This is precisely the reason why we launched the One You campaign because we’ve so often in the past tackled these risk factors individually and we haven’t really brought them together so that people can understand their interconnectedness.
Question 4 (role of faith groups)
Faith organisations have an important role in passing on messages about a healthy lifestyle but also in combatting loneliness in people. Is there anything else that we could be encouraging our members to do?
Answer: Faith groups, community organisations and communities of faith have such an important role to play. Firstly in promoting that social connectedness and addressing loneliness, but across the country we have seen how faith groups have also got involved with the wider aspects of wellbeing. So getting people more physically active, ensuring that messages around health and protecting one’s health are integrated into key messages. There are some great examples across the country.
Faith groups also have a real role to play in raising awareness specifically about dementia and this new message that there are aspects of dementia which are preventable and that all of us can take an active role in helping to reduce our risk of dementia. There are many opportunities for collaboration here.
Question 5 (role of the health visitor)
We conduct assessments of people’s general health and social needs. We also pick up and screen for dementia. Are there any activities and advice we can give to older people who may be developing cognitive impairment, to help keep them well?
Answer: It’s never too late to change your behaviours. We know that stopping smoking, for example, contributes to a healthier life at whatever stage you stop smoking. Clearly it’s better to stop earlier than later but it’s never too late to start.
But what’s most important, especially when thinking about older people, is that they remain connected and this really picks up with the previous question. Because if there’s one thing that really worries people, especially after retirement age is that they become more and more isolated in some cases and also their world starts to close around them and grows smaller.
Remaining connected to their world and remaining connected to people around them is particularly important, as it helps to maintain an interest in life and also it ensures that people continue thinking. Thinking is really quite important – people talk about use it or lose it in terms of cognitive function. There is a growing body of evidence that perhaps it’s important to maintain cognition at whatever age so that the longer people remain cognitively challenged the better.
But your work around making sure people remain physically active, ensuring that people remain physically connected, ensuring that people eat healthily (there is a balance here between malnutrition, which becomes a problem in older age sometimes, and obesity) and ensuring people remain mentally stimulated is exactly what should happen.
Question 6 (dementia-friendly cities)
What is your opinion of dementia friendly cities?
Answer: There’s a fantastic opportunity to link both the messages here in Health Matters about the individual changes we can make, with some of the wider structural and social changes that we can put in place across the country to help respond to the crisis.
Dementia-friendly cities are certainly one way in which we can have a place-based approach to responding to this. We need to make our cities places where people with dementia can live as comfortably as they can. There is absolutely no reason why we shouldn’t be able to deliver this: a lot of this isn’t about delivering an expensive new initiative, it’s about behavioural change in how we think about the way we allow people to live and communicate with each other in our cities. A lot of this is starting to happen but inevitably it’s going to take a bit of time.
We can look at way we think about signage, how we promote social connectivity within cities, ways in which we can promote physical activity during the life course. With all that we know will work at an individual level, we can look at the ways in which we can influence the design, the social and cultural content of cities that help support that as well. There are some fantastic opportunities.
Question 7 (dementia action alliances)
I wonder how well these dementia materials are linked in to dementia action alliance groups across the country because they are really linked in and engaged with local stakeholders. That might be a helpful way to get the message out.
Answer: Dementia action alliance groups are really the structure we depend on to carry those messages. They are the ideal structure as you say, because they are of the community they come from and are connected to where they live. We need to ensure that that connection exists and encourage that connection.