18 minute read
Alive... and Well?
from 2025 RCSI Alumni Magazine
by RCSI
While getting old is a privilege, it is something most do not look forward to. The possibility of physical frailty and loss of independence can instil a sense of fear. However, there are conscious choices we can make that could help us age well
The good news is that ageing well is something we can all work towards throughout our lives, making conscious choices that will benefit our older selves. Staying active and maintaining a healthy weight are two of the most obvious, as is the effective management of conditions such as diabetes and hypertension. Engaging with screening and vaccination programmes is prudent, and addressing issues with hearing and sight as they arise rather than ignoring them is important not just in terms of the physical issues but as they impact upon cognition and brain health.
Surgeries for knee and hip replacement should not be feared but embraced as opportunities to improve quality of life. There has been a significant recent breakthrough in the treatment of Alzheimer’s disease, and while these drugs are not yet available in Ireland, experts expect them to become increasingly important in the future.
One of the most interesting things to emerge from recent research across a number of fields is how vital social connection is to ageing well. Exercising with other people is more beneficial than doing it on your own, and practising mindfulness techniques while you exercise enhances the value of the workout. Studies show that simple social activities such as walking with a friend or joining a book club pay dividends in terms of positive ageing and cultivating a growth mindset. We spoke to RCSI alumni and faculty who are experts in the field of ageing and asked them for their tips on ageing well.
DR JÜRGEN BLUDAU, MEDICINE, CLASS OF 1987
Former Chief Clinical Director of Geriatric Services, Brigham and Women’s Faulkner Hospital | Current Chief of Geriatrics, SLK Clinic, Heilbronn, Germany | Author, Ageing But Never Old (2010), published in Germany as Getting Old is Fun (2022).
The title of my book is deliberately provocative because when you do it [ageing] correctly, it’s true, but you do need to work at it.
In your 60s, you need to take preventative action. That means regular skin, ear and eye checks, colonoscopies, cardiac evaluations, and taking vaccinations against flu, COVID-19, pneumococcal disease and shingles so that you stay as healthy as possible. Women need to keep on top of gynaecological health and have regular mammograms. The urologist is a man’s best friend.
You also need to be as active as possible, so rather than sitting around eating crisps and drinking beer it’s important to continue to play sport, go to the gym and keep your weight under control by taking regular walks and watching what you are eating. Weight is important for cardio and joint health. If you take these measures, you’ll be as healthy as you can be for the next 20 years, but if you mess up at 60 the next 20 will not be fun. That is, if you get 20 more years.
In your 80s, mobility is key to quality of life. If you are not mobile, your life can become very narrow. If you use a walker or a cane that’s ok. It’s important to control diabetes and hypertension, and to have a good podiatrist to deal with ingrown toenails and the like.
Staying socially connected and mentally active is vital. Doing the crossword and other puzzles such as Sudoku is fine, but being part of a book club where you get to meet other people and listen to their opinions is better for improving cognition. Being alone increases the risk of dementia, so you must make an effort to do things in a group and be as social as possible, even if it’s just going for a walk with a neighbour.
DR PÁDRAIC DUNNE, RCSI SENIOR LECTURER
Immunologist (research scientist), psychotherapist, and board-certified lifestyle medicine professional | Senior Lecturer, RCSI Centre for Positive Health Sciences (CPHS) | Principal Investigator of the Digital Health Research Group within the Centre.
While our lifespan in Ireland has increased dramatically in recent times, with a life expectancy of 83 years, our health span is not much greater than it was in the 1960s (65 years). For many of us, our health deteriorates in our 50s and 60s because of mostly lifestyle-related non-communicable diseases including heart and lung disease, certain cancers, diabetes, serious mental health disorders and obesity. However, it does not have to be this way.
RCSI’s Centre for Positive Health Sciences promotes evidence-based practices that combine lifestyle medicine, positive psychology and health psychology. This approach begins with enhanced self awareness and an orientation toward positive health (heliotropism), regardless of the ageing process or diagnosis with a chronic disease. Having a growth mindset toward living a healthier life can help. It’s hard to make change but if we adopt a flexible and self-compassionate growth mindset, we are more likely to make small changes for better, sustained health. We also know from the longest study conducted (Harvard Study of Adult Development – 1938 to the present day) that the two practices most associated with healthy ageing are meaning in life and positive social relationships.
Positive health approaches add to the recommended guidelines on healthy living such as getting 150 minutes of moderate exercise each week. When you run or walk on a gym treadmill, you will meet your recommended weekly requirements. However, positive health recommends that you integrate a multitude of practices that simultaneously foster better physical, mental and social health. For instance, the previous example can be modified to include cultivating gratitude for being alive as you run, as well as being fully present in the moment. Trees generate phytoncides that protect them from harmful fungi. If you can run in a forest, you will breathe in these natural chemicals, which in turn activate our bodies’ natural killer T cells, agents within our immune system that destroy cancerous cells. We know that exercising in a social context – a good example is the Park Run phenomenon – can also boost health outcomes.
In short, doing our best to make small changes to our lifestyle, accompanied by a healthy dose of self-compassion, can go a long way to slowing the ageing of our immune system. e result can be a longer health span.
DEIRDRE LANG, GSM, CLASS OF 2017
FFNMRCSI, MSc Leadership, BSc Nursing, PGDip in Gerontology (Nursing) | Director of Nursing Lead for Older Persons’ Services, National Clinical Programme for Older People, Office of the Nursing and Midwifery Services Director, HSE.
My role as Nurse Lead is to lead on the nursing contribution to the care of the older person across the spectrum of healthcare. The National Frailty Education Programme is one of the programmes of work I have led on in this role. This is an inter-professional integrated approach to learning, providing healthcare professionals with the knowledge and skills they need to have to care for the older person living with frailty. It is regarded as a key enabler to integrated care, advancing coordinated working and collaboration, and adopting an age-attuned approach to better meet the needs of older people.
We are in the process of adapting the Programme to empower the public with information that will support them to age well, and help them understand that the more they invest in their health now, the greater their chances will be of ageing well. The Programme will promote the concept that we should consider investment in our health as investing in our future older selves. It’s akin to investing in your pension; the more you put in now, the more you benefit at retirement.
Muscle mass is one of the key elements to how we age, so we need to ensure we are eating a balanced diet and moving our body to the best of our ability. For some people, that is walking, cycling or going to the gym. For others, it is sitting to stand, or chair-based activities. It differs for everyone depending on your current level of ability. Whatever it is, it should ensure you are maintaining or building on what you could do yesterday so that you are retaining muscle mass and reducing muscle loss.
The adaptation of the Programme also aims to inform those who are caring for their relatives who are living with frailty. It will equip them to recognise how different aspects of frailty present, and what can be done to reduce it, where appropriate, in order to best support their relatives. It will help the public understand that sitting and social isolation are detrimental to the ageing process and, like smoking, are modifiable risks that can be addressed. Our motto for our future older selves should be: “Get up. Get dressed. Get moving.”
MR NIALL HOGAN, MEDICINE, CLASS OF 1995
MB, BCh, MSc, FRCSI (TR and Orth) | Consultant Orthopaedic Surgeon.
Ensuring good joint health as you age starts when you are young. It’s important for young people to get into and enjoy sport and exercise, whether as an individual or as part of a team. We need to make sure young girls don’t drop out of sport.
In your 20s and 30s, it’s important to stay healthy by going to the gym and eating well. The Mediterranean diet has been shown to be the best, but everything should be in moderation – especially alcohol. It’s too easy to put on a few extra kilogrammes, so it’s important to keep weight under control.
Later, continuing to exercise is key. Whether that’s walking, gym, golf or tennis it doesn’t matter, you need to keep going as long as you can, into your 70s and 80s if possible.
It’s important to listen to your body. If you have a painful joint, modify your activity accordingly. If you’re a runner, think about taking up cycling or swimming instead and transition to non-impact sports. If you’re a hillwalker, you may find it easier to walk on the flat.
Educate yourself in relation to joint problems and seek advice initially from a physiotherapist and then an orthopaedic surgeon. It may be a good idea to take a painkiller or anti-inflammatory on the day you are playing golf, for example. The next step is to get cortisone and/or hyaluronate injections. Eventually, through no fault of your own, a painful joint may need replacement. Joint replacements are very successful and can be lifechanging, though nothing is 100% guaranteed. We say that we have a 95% success rate with hips and 90% with knees.
Patients should not fear the prospect of joint replacement. Surgical techniques and technology are improving all the time. Robotic surgery for knee replacement is more accurate and precise and I believe my patients have better outcomes with robotic rather than non-robotic surgery. In relation to hips, robotic surgery is not yet common in Ireland, however post-operative rehab is now much shorter than it used to be, and patients mobilise sooner.
In the older population, particularly post-menopausal women, it’s important to have a DEXA scan and be aware of bone density and osteoporosis in terms of fracture risk and to take calcium, vitamin D and other medications to reduce the risk. Fractures can be very debilitating and lead to loss of movement and function, while a broken hip often leads to loss of independence.
GILLIAN HARTE, PHYSIOTHERAPY, CLASS OF 2009
BSc Physiotherapy, MSc Advanced Professional Practice in Neurological Rehabilitation | Clinical Specialist Physiotherapist in Stroke, Tallaght University Hospital.
I currently work in the stroke service in Tallaght University Hospital, where I was involved in establishing an interdisciplinary service for people with stroke, with the goal of reducing the risk of readmissions and functional decline. I have also established a physiotherapy-led spasticity management clinic as part of this service.
From the physiotherapy perspective, the best way to reduce the risk of stroke is aerobic exercise, either 150 minutes of moderate or 75 minutes of vigorous exercise per week. It’s important to get the heart rate up, so you are breathing more heavily. Cycling, walking and swimming are all good. Exercise in groups ticks all the boxes for social connectedness.
Post stroke, patients are often afraid of becoming breathless, but the risk of breathlessness is outweighed by the risk of not exercising. Those who have had a stroke and take up exercise can reduce the risk of recurrence by 20%, and those who abide by the whole package of measures we advise – exercise, dietary, smoking cessation and medication – reduce their risk by up to 80%.
The impairments caused by stroke may make it difficult to be active, and this can cause further weakness and problems with moving around, creating a vicious circle. Strengthening exercises and resistance training are like paying into a muscle pension, you need to have muscle banked in case you are sick and can’t be as active as usual for a week or two. By being less active you will lose some muscle, so you want to have enough muscle banked so your ability to move about and perform day to day tasks won’t be affected. We lose muscle from our 30s onwards so this is very important for everyone, but even more important for those who have had a stroke.
One key development is in the area of research into gait speed as a predictor of mortality, more so than age or gender; it’s now seen as the sixth vital sign. If we measure gait speed regularly, we can investigate what is going on to cause any drop. Gait speed can predict who is likely to survive cardiac surgery, is the strongest predictor of falls, can distinguish between who is frail and who is not, and predict who is most likely to be in a nursing home within two years. Typically, we don’t use gait speed to its potential because it is hard to measure but there is a new Irish subscription-based GaitKeeper app, which I’ve been involved in developing and it is an exciting tool for assessing, managing and triaging, as it brings the Gait Lab into any setting, enabling us to track wellness and determine when to intervene. For instance, if a patient is discharged from the stroke service and reassessed a year later, and their gait speed has dropped, we can investigate why. It’s a wellness thermometer.
DR SINÉAD CRONIN, MEDICINE, CLASS OF 2011
MB, BCh, BAO, LRCP & SI, MICGP, DOWH, PgDip in Clinical Education | GP Partner/Owner, Drumcondra Medical.
Ageing is a privilege, but it’s tricky. My husband and I run a large, busy GP surgery in Drumcondra, Dublin and we see this every day. The average life expectancy in Ireland is now north of 82 years old and our population is ageing, with 18% of our population aged 65 and over. We have more and more people living longer with significant levels of multimorbidity and polypharmacy.
Engaging with primary care is important as we age. GPs are well placed to manage patients with multiple chronic conditions. The Chronic Disease Management (CDM) Programme being run in primary care across Ireland is a fantastic way to do this. CDM aims to provide comprehensive, community-based care to patients with several specific chronic diseases: Type 2 diabetes, COPD, asthma, A Fib, previous stroke/TIA, angina and CCF. It involves an annual or biannual doctor and nurse review with medication review, patient education and management planning as well as a strong emphasis on prevention.
By providing proactive management, the Programme aims to reduce unnecessary hospital admissions and emergency department attendances. By managing conditions early in the community setting, patients are less likely to experience serious exacerbations or complications that require hospital admission.
We all know about the importance of keeping physically fit as we age, but keeping your brain active is vital too. I tell patients that doing their morning Sudoku or crossword is as important as taking their aspirin or statin!
Combating isolation by encouraging social connection is important too. As medics, we must help our patients carve out these supports – be they with family or community groups. Feeling socially connected has a positive effect on our mental health.
Taking a practical approach to ageing, we encourage patients to attend their tertiary care appointments with someone, so that someone else can absorb all of the information, ask questions and take notes, especially if the patient is nervous. We also encourage patients to speak with their families about their wishes in relation to decisions about medical treatments and an enduring power of attorney. It’s so important that their values and wishes are respected.
Finally – if people are concerned about something, they should make an appointment to see their GP. We know general practice is under pressure in Ireland and across the world, but it’s important that patients know that we are available and ready to listen, and that they are never wasting our time.
DR ANDREW EUSTACE, MEDICINE, CLASS OF 1993
MB, MRCPI, MRCPsych | Consultant Psychiatrist, Consultant in Psychiatry of Old Age, Highfield Healthcare.
The research into dementia prevention appears to show that changes in the brain start to occur in our 40s, when we begin to lose cells in the brain and increased inflammation damages the connections between cells in the hippocampus. The 2024 update of the Lancet Commission on Dementia shows that the implementation of lifestyle changes such as reducing weight, cutting down on alcohol, ceasing smoking, exercising, remaining socially connected, treating conditions such as blood pressure and diabetes, and correcting difficulties with eyesight and hearing can help prevent dementia.
There are exciting new drug treatments for dementia which appear to modify the course of Alzheimer’s disease by breaking down amyloid deposits in the brain and slowing down the progression of the disease. ese have been approved by the FDA in the US but have not yet been approved by the EMA. There is wariness about them because of potential side effects including brain bleeds, thus requiring monitoring and scanning, which we are not set up to deliver at scale in Ireland, and the financial cost is high. However, they mark the first positive message in the treatment of Alzheimer’s disease in some time and offer potential hope of other novel agents being developed.
DR FANTA O’BRIEN, MEDICINE, CLASS OF 2004
MICGP, MB, BCh, BAO, LRCP & SI, MSc LHPE, MSc in Global Health | Assistant Scheme Director in the North East Training Scheme | Director, Santé des Femmes Complex Menopause Clinic.
Menopause is a significant transition in a woman’s life, marked by the cessation of menstrual periods due to a decrease in reproductive hormone levels. Perimenopause is the stage when a woman begins to experience menopausal symptoms, even though her periods have not yet stopped. Menopause is officially reached after a woman has gone 12 consecutive months without a period.
Typically, menopause occurs in women between the ages of 45 and 55. As life expectancy continues to rise globally, women may spend one-third of their lives in menopause. is transition can significantly impact physical health and overall wellbeing, highlighting the necessity for effective management to enhance quality of life and promote positive ageing.
If menopausal symptoms are not addressed properly, they can accelerate biological ageing. Hormone replacement therapy (HRT) is commonly used to alleviate symptoms and may involve the use of estrogen, progestin, or a combination of both. HRT is a key option for many women, but it is crucial to tailor this treatment to individual health needs, as each woman’s situation is unique. For those who may not be suitable candidates for HRT, there are alternative treatments such as non-hormonal medications and psychological therapies.
Recent research indicates that women using HRT often enjoy better health outcomes than those who do not. This may contribute to longer and healthier lives. While some studies suggest a possible link between HRT and an increased risk of dementia, the evidence remains inconclusive. However, many findings indicate that starting HRT before age 60 or within ten years of menopause onset can reduce the risks of mortality from various causes, including heart disease. Additionally, early use of HRT may help prevent type 2 diabetes and bone fractures in women under 60. Timing is essential for the effectiveness of HRT. ■
