Ebook: Active Ageing and Healthy Living

The book Active Ageing and Healthy Living: A human centered approach in research and innovation as a source of quality of life fulfils, above all, a twofold purpose.

First, setting out in systematic manner the results of some among the numerous research projects that the Università Cattolica del Sacro Cuore of Milan has launched and supported in recent years, also with autonomous financing – fact that is not common within the national scenario. All these projects deal with topics which are considered strategic for the Università Cattolica del Sacro Cuore and are carried out in an interdisciplinary perspective.

Second, proposing visions matured on the basis of research developed thus far and that constitute fruitful experiences on which the Università Cattolica del Sacro Cuore will centre its research in the near future.

In this sense, aside from its specific contents, the book intends to be a significant demonstration of the Università Cattolica del Sacro Cuore's commitment to interpret in original and proactive way its nature as a ‘research university’; a commitment which, besides relying on a solid basis of non-material and material resources for research activity, consists in pursuit of essential values and methodologies which find a first and fundamental starting point in the high scientific profile of research projects and their participants.

On these basis, a close attention to the social and human relevance of the topics on the research agenda, the conduct of multidisciplinary research (in response to the multidimensional complexity of the problems brought to the attention of scientific research) and, finally, a propensity to network with ‘social worlds’ (politics, industry, third sector, public opinion) engaged in the co-management of the research results, are integrated.

The topic of active ageing and quality of life (Active Ageing and Healthy Living – AA&HL) concerns people development, as both individuals and group members, and, for this reason interlaces and crosses a plurality of disciplinary fields; thus, this topic lends itself well to verification of the Università Cattolica del Sacro Cuore's scientific positioning in recent years as concerning its various and rich expressions and commitment in the social and human science, life science and mathematical and physical sciences: disciplines that are featured by heterogeneous knowledge and methods which are called to join a shared research field.

Moreover, this is a topic central to the mainstream of European research, that is leading the construction of its scientific agenda. Consider, for instance, the close attention paid to the AA&HL topic within the Horizon 2020 research programme, as well as the emergence of the Knowledge Innovation Communities (KIC) now organizing themselves around this topic whose implications on anthropological and cultural levels are now crucial and more and more relevant for the next future.

The Università Cattolica del Sacro Cuore, deeply involved and active in the main academic European scenarios, thus equipped itself in the aim to contribute to the collection and analysis of scientifically validated data which may be useful for the management of the future scenarios.

Moreover, the Università Cattolica del Sacro Cuore aims at further improving its capacity to generate proposals that may concurrently contribute to the scientific knowledge advancement and be useful to orient policy and institutional decision makers. To conclude, the aim of increasing the quantity and quality of life by fostering people's active engagement in healthcare practices constitutes a ‘value choice’ at both the scientific and social levels; a choice long taken by the Università Cattolica del Sacro Cuore and which today is confirmed for the future.

Franco Anelli

Rector of the

“Università Cattolica del Sacro Cuore”

(http://www.ucscinternational.it/)

Population ageing is a major challenge for European Union (EU) society and economy, particularly for Italy, which is the oldest country in Europe. According to the World Health Organization, two-thirds of European citizens who have reached the retirement age suffer from at least two chronic conditions, with a strong pressure on healthcare systems. Moreover, EU countries already spend, on average, more than a quarter of their gross domestic product on social protection, above all pensions, health and long term care. The current financial crisis is putting a strain on this system. In this context, it becomes increasingly necessary to promote a healthy and independent ageing, by improving outcomes for patients and society while ensuring health systems sustainability. To this purpose a proactive approach to chronic diseases prevention (primary, secondary and tertiary) as well as an integrated healthcare approach and also patients' empowerment are required so as to make daily life more age-friendly. It is also necessary to share health and social best practices, adopt policies really effective against elderly social exclusion and strengthen older people participation in society. A joint effort of all key stakeholders is needed to create a society in which older people can play an active role.

The quest for an active and healthy ageing can be considered a “wicked problem.” It is a social and cultural problem, which is difficult to solve because of incomplete, changing, and contradictory requirements. These problems are tough to manage because of their social complexity. They are a group of linked problems embedded in the structure of the communities in which they occur. First, they require the knowledge of the social and cultural context in which they occur. They can be solved only by understanding of what people do and why they do it. Second, they require a multidisciplinary approach. Wicked problems can have different solutions, so it is critical to capture the full range of possibilities and interpretations. Thus, we suggest that Università Cattolica del Sacro Cuore (UCSC) is well suited for accepting and managing this challenge because of its applied research orientation, multidisciplinary approach, and integrated vision. After presenting the research activity of UCSC, we describe a possible “systems thinking” strategy to consider the complexity and interdependence of active ageing and healthy living.

Demographic changes bring about a wide range of new research fields including policy topics, health, social welfare, work & productivity, urban & rural development, communication tools, and mobility. This new situation requires a new multi-disciplinary approach bringing together different research programs in order to provide solutions for the upcoming challenges. National Health services are now facing a huge shift in the population structure with a predominance of older generations in the total number of citizens. Good health is the most important factor to live independently in old age. A better understanding of ageing processes and the related “plasticity” of individual performance for environmental adaptation, the prevention for age-related illnesses and healthcare strategies are the basis for keeping very old people healthy and active throughout the course of their lives. We will face mainly the biological, cognitive and psychological dimensions of ageing. Afterwards, we will focus on the relationships linking various biological and lifestyle factors – such as nutrition – that are crucial to obtain a comprehensive picture of ageing and to promote preventing strategies against degenerative neurological diseases. Finally we will investigate which interventions – nutritional and physical – could help in keeping people healthy, in particular which factors could promote people's physical, social and psychological functional abilities and the systemic multilevel consequences induced by a healthy ageing.

The link between diet and health has been recognized since the Grecian period; as Hippocrates said, “Let food be your medicine and medicine be your food”. Although the primary goals of diet are meeting nutritional requirements and providing energy, there is increasing awareness that a correct and balanced diet may prevent the insurgence of diet-related pathologies and/or improve well-being and life expectancy, also reflecting on the ageing process. Research on the interaction among nutrients, gut microbiota and host metabolism is presently unravelling the molecular mechanisms underlying the positive and negative effects of traditional diets on health and ageing, providing useful information for the design of innovative foods targeting specific needs and segments of the population. The food supply chain plays a key role in ensuring quality and safety through both comprehensive quality management and inspection systems and a focused innovation process mainly devoted to the creation of functional foods. However, innovation and scientific development pose a problem of information asymmetry towards final consumers; thus, regulatory aspects and private and public communication strategies must be efficiently developed.

Information and communication technologies are widely and rapidly spreading in people's daily lives. But what is the possible role of the mass proliferation of digital devices in supporting healthy living and active ageing? Are they useful in fostering personal growth and individual integration of the elderly, by promoting satisfaction, opportunities for action, and self-expression? Rather, do they enhance automation, impose constraints on personal initiative, and result in compulsive consumption of information? In this chapter, we suggest that possible answers to these questions will be offered by the “Positive Technology” approach, i.e., the scientific and applied approach to using technology so that it improves the quality of our personal experiences through its structuring, augmentation, and/or replacement. First, we suggest that it is possible to use technology to manipulate the quality of experience with the goal of increasing wellness and generating strengths and resilience in individuals, organizations, and society. Then, we classify positive technologies according to their effects on these three features of personal experience – Hedonic: technologies used to induce positive and pleasant experiences; Eudaimonic: technologies used to support individuals in reaching engaging and self-actualizing experiences; Social/Interpersonal: technologies used to support and improve the connectedness between individuals, groups, and organizations. Finally, we discuss the possible role of positive technologies for healthy living and active ageing by presenting different practical applications of this approach.

This contribution is a reflection on the concept of active ageing from the perspective of relational sociology. At the same time, it offers practical implications and outlines possible future courses of action, in the face of demographic and relational scenarios rapidly changing, and the challenges that each day people of all generations are called to cope with. Active ageing is quite a recent concept and indicates an attitude towards ageing that enhances the quality of life as people become older. The goal of active ageing is to enable people to realise their potential for physical, social and mental well-being and to participate in social life also in the last stage of the life cycle. In this phase, the presence of a network of support, security and care adequate to the possible onset of problems and criticalities is crucial. Relational sociology frames the phenomenon of an ageing population in a dense network of social relations, primarily at the level of family and community. For this reason, as supported by the most recent sociological literature and evidence from studies conducted in Italy and abroad (cf. SHARE), it is extremely important to investigate the link between active ageing, intergenerational orientation (solidarity and exchanges) and practices of prosociality (i.e. engagement in third-sector activities and volunteering in later life).

In developed countries, economic and financial well-being is playing a crucial positive role in ageing and inclusion processes. Due to the complexity and pervasiveness of financial economy in the real life, more and more social as well as individual well-being are perceived as influenced by financial conditions. On the other hand, the demographic circumstances drive scholars as well as politicians to reflect on ageing dynamics. Bridging the two domains, the following research focuses on the role of the financial well-being as a mediating role of general well-being in elder people. The assumption is that elderly people have specific financial needs that sometimes are not covered by financial providers' offers. The motivation is mainly on the role of information asymmetries between elder consumers and financial institutions. On the dynamics of these asymmetries, the research will specifically investigate the role of financial literacy, as the ability of comprehension of elder people of their needs and of financial information. The applicative implication of this research work consists in finding the determinants of financial well-being for elders and the definition of their specific financial competencies, in order to 1) identify educational and regulatory guidelines for policy makers in charge of creating financial market transparency conditions, and to 2) support design of organizational mechanisms as well as financial product/services for this specific target of client. The following chapter presents preliminary explorative results of a survey delivered on 200 elder individuals (65–80 yrs.) leaving in Milan. Findings show that active elders consider the ability of managing personal wealth as one of the core determinant of well-being, although the economic and financial literacy is limited. Furthermore, the chapter proposes a research agenda for scholars interested in exploring the relationship between financial well-being and ageing.

In the literature, different criteria have been validated to identify frail older subjects, which mainly refer to two conceptual models: the cumulative deficit approach proposed by Rockwood and the Physical Frailty (PF) phenotype proposed by Fried. Both models have received empirical validation. Nevertheless, the frailty phenotype is the most widely used and presents a characterized pathophysiologic background. The PF condition depicted by the frailty phenotype has shown to be predictive of major negative health-related outcomes, including mobility disability, disability for activities of daily living, institutionalization, and mortality. At the same time, it cannot be ignored that the PF phenotype presents substantial overlaps with sarcopenia, “a syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength with a risk of adverse outcomes such as physical disability, poor quality of life and death”. In fact, many of the adverse outcomes of frailty are probably mediated by sarcopenia. Therefore, sarcopenia may be considered both as the biological substrate for the development of PF and the pathway through which the negative health outcomes of frailty ensue. Although PF encompasses only a part of the frailty spectrum, the identification of a definite biological basis (i.e., skeletal muscle decline) opens new venues for the development of interventions to slow or reverse the progression of this condition. Here, we present a novel conceptualisation of PF which will possibly promote significant advancements over the traditional approaches to this syndrome by enabling the precise operationalisation of the condition, a clear identification of the affected population and the rapid translation of findings to the clinical arena.

The last decades' changes in the epidemiological trends of chronic disease – also due to the ageing population – and the increased length and quality of life among the majority of Western population have introduced important changes in the organization and management of the healthcare systems. Consequently, health systems throughout the world are searching for new and effective ways to make their services more responsive to new patients and the public's health needs and demands. The idea of patient engagement – borrowed from the marketing conceptualization of consumer engagement – moves from the assumption that making patients/clients co-producers of their health can enhance their satisfaction with the healthcare system as well as their responsibility in both care and prevention by improving clinical outcomes and reducing health delivery costs. To make people aware of their health services options by supporting them in the decision-making process and to engage them in enacting preventive and healthy behaviors is vital for achieving successful health outcomes and preventing waste of resources. In this chapter, we outline a model (PHE model) that explains the patients' subjective experience with their health management process and the levers that may enact the passage from one phase of the process to the other. Based on this conceptual model of patient engagement will be proposed a tool kit of priority actions that may sustain the patient in its process of engagement.

The increase in life expectancy has dramatically enhanced the prevalence of age-related chronic diseases resulting in growing costs for both society and individuals. Identification of strategies contributing to healthy ageing is thus one of the major challenges of the coming years. Lifestyle has a primary role among non-genetic factors affecting health and lifespan. In particular, nutrition, mental and physical activity impact the molecular and functional mechanisms whose alterations cause the major age-related diseases. A better understanding of mechanisms underlying the beneficial action of correct lifestyles is useful to develop interventions aimed at preventing and/or delaying the onset of chronic degenerative diseases, to identify high-risk populations who could be targeted in intervention trials as well as to identify novel biomarkers of healthy ageing. A multidisciplinary team of basic scientists and clinicians operating at the Catholic University Medical School in Rome is actively working on this topic to determine the ability of healthy lifestyles to promote active ageing and counteract the major age-related diseases affecting brain health, musculoskeletal function and gut microenvironment. This chapter summarizes our strategic approaches, the major results we obtained so far and the main experimental and translational perspectives.

The world elderly population is rapidly increasing. This demographic change represents a new challenge for the society and demands for a multisectorial intervention to promote a long, healthy, and active life span. Between the factors that contribute in fostering a long healthy life, the nutritional regime plays a central role and is recognized as a major factor in the onset of chronic diseases. A better understanding of the interaction between nutrition and ageing is essential to unravel the mechanisms responsible for these positive/negative effects and to identify diet components promoting the quality of life in the old age and to contribute to the prevention of late-life disabilities. At Università Cattolica del Sacro Cuore, the research activity in food science is focusing on four main objectives: food quality, food safety, functional foods and diet balancing. These objectives are the target of multidisciplinary ongoing and future research activities for a better understanding of the link between diet and ageing. Briefly, the different activities are addressed to the study of the following subjects: the most relevant factors affecting food choices and habits of old aged persons; the effects of long term low dose supplementation of conjugated linoleic acid in mouse; the use of low glycemic index and high resistant starch foods to prevent diabetes and obesity; the adjuvant effect of food bacteria for vaccination; the role of food ingredients in disease; the immunosuppression effect of mycotoxins, and its relevance in ageing people; the production of sustainable and natural antioxidant ingredients to encourage a healthy diet. Our research projects emphasize an holistic and integrated approach that, by bringing together complementary research groups, can combine the collective expertise and thus provide a comprehensive assessment of the role of nutrition in healthy ageing people.

A healthy and active life is a key issue for elderly citizens, above all when psychological complications such as depression and anxiety disorders, late delusion or loneliness can be observed. Moreover, medical pathologies in elderly patients often have a multi-factorial etiology and many psychopathological dimensions and psychosocial risk factors are underestimated. From the perspective of clinical health psychology, psychogeriatrics could play an important role in promoting active ageing and a healthy lifestyle in elderly persons through tailored clinical approaches based on specific research and advanced professional training in this area. More research is needed in order to study which determinants affect the process of an active and functional ageing. Possible research ageing areas are: 1) evaluation of psychosocial risk-protective factors related to the individual's biography and personality. 2) Evaluation of enrichment programs and clinical protocols focused on the management of different topics such as health system areas, behavioral areas, social and physical environment areas, psychological factors and economic determinants. The goal of Psychogeriatrics endeavors to develop and evaluate interventions designed to stimulate improvement in friendship, self-esteem and subjective well-being, as well as to reduce loneliness among older citizens. 3) Evaluation of self-management programs in chronic disease conditions (such as obesity, diabetes, hypertension, poor nutrition, physical inactivity, alcohol abuse and tobacco smoking), that could enhance risk factors for health in elderly citizens. Typical key elements of self-management, such as decision making, problem solving, motivation, self-efficacy, resource utilization, and citizen's empowerment have to be studied.

Prolonging working careers by increasing the statutory age for retirement has become compulsory in most Western societies in order to tackle the shrinking of the labour force, preserve economic productivity, foster knowledge transfer and reduce the risks of financial imbalances in social security systems. This imperative currently results in working careers that already exceed 40 years and come to an end after the age of 65 (e.g. in Italy). Over the next few decades, both career length and retirement age are expected to rise. Thus, creating more inclusive workplaces by increasing their quality is the precondition of a win-win situation for both employers and employees, regardless of age. A request for support in the development of sustainable careers from both private and public labour organisations has led to innovating the mainstream methodologies and research tools in the field of age management. Based on the key elements of the mainstream “work ability concept” – i.e. health, competencies, motivation and work organisation – the Quality of Ageing at Work questionnaire (QAW-q), developed by a team from the WWELL Research Centre, broadens its perspective by surveying elements bridging intra-organisational dimensions and which affect employees' conditions and external socio-institutional constraints: i.e. work-life balance, economic stability, professional identity and relationships in the workplace. The QAW-q is designed to analyse the influence of the different meanings of age (chronological age, seniority within the company and in the labour market) and correlate them with the different dimensions at individual and organisational levels; all these dimensions are weighted by the effect exerted by the passage of time. The results of the QAW-q survey, taken by employees of both private and public companies, serve as a basis for the implementation of measures addressing all the relevant dimensions of the human resource management cycle.

Ageing in western society has become a key issue in political and academic debate: politicians, sociologists, doctors, demographers, psychologists, economists are trying to understand how ageing will impact our future society. In this frame, media and communication technologies seem to be more and more relevant for the elderly, thanks to those services and devices helping people to grow old actively. Technologies, the Internet and ICTs could help the elderly to improve their quality of life, to be healthy and independent and to get better assistance. Our ongoing research investigates the relationship between the elderly and use of technologies, and explores the role played by media and ICTs in building a friendly and positive environment for the elderly, and in constructing and maintaining social relations and promoting healthy ageing. Specifically, the research will investigate the use of ICTs by the elderly by taking into account two different perspectives: a) Exchanges between generations: lengthening of life corresponds to a longer period of cohabitation between at least three generations (grandparents, children, grandchildren), and also of co-use of digital media. The research wants to investigate relations between two age groups (grandparents and grandchildren; young people and older people) to understand the dynamics of intergenerational mutuality in the use of technologies and ICTs. b) Media, ICTs, Health: the Western world is increasingly populated by elderly population. Technologies and ICTs can help elderly people to improve their quality of life, to be healthy and independent and to get better assistance. ICTs should encourage active ageing and, in the case of health technologies, new models of care. The project, lasting 1 year, is based on (1) a survey on young elderly (65–74 yrs) population in Italy, and (2) a field-work which consists of family interviews and ethnographical sections in natural contexts.

The chapter is aimed at describing four different approaches, each supported by experimental findings, which can be adopted to empower life skills in the elderly. The first approach consists in stimulating aged persons by asking them to carry out some tasks aimed at activating the brain and mental processes which are targeted by the intervention. In the second approach the elderly are hinted at thinking about their mental states to understand one's own and others' behavior to act as a reflective agent. The third approach is based on the assumption that the communication context can support and improve old people's skills, if the messages they receive are devised so to focus their attention on relevant information and to elicit relevant cognitive frameworks. According to the fourth approach, aged people can be engaged in activities which enjoy them so to express themselves in personal ways and to practice a wide set of mental functions. Becoming aware of the pros and cons of each approach enables us to choose the kind of intervention which is most suited to the elderly, taking into account the features of the context and the actual resources which can be employed. We also aim at integrating the different approaches so to devise a holistic intervention in which synergies among the methodologies to be applied occur.

In recent decades many industrialized countries experienced a substantial decrease in the working age population as a proportion of the total population. Demographic factors, such as declining fertility and increasing life expectancy, as well as institutional factors, such as the generosity of state-funded pension, both determined a change in the age distribution and a marked anticipation in retirement age. A lively debate among researchers and policymakers is currently taking place in Europe, as there are concerns that working longer may not be healthy for workers, or that it will be hard for older workers to get a job. Conversely, if working longer leads to higher employment rates and better health conditions, policies aimed at increasing peoples' retirement age may represent a “win-win” strategy both in terms of fiscal policies as well as in terms of healthy life expectancy. Unfolding this controversy is essentially an empirical matter which is also of paramount importance for public policy. In this study we first review the main findings of the socio-economic literature. Second, we highlight the main research avenues that are currently investigated in the area of Social Science and Health Economics at the Universitá Cattolica. Finally we discuss the policy implications and the prospects for future research.

The ageing of biological tissues can be accelerated by many factors, mainly of physiological and nutritional nature. In the case of skeletal muscle tissue, one of the main consequences of ageing is a progressive loss of muscle mass and a worsening of the quality of muscle tissue, termed “sarcopenia”. The correlation between the deterioration of muscle tissue and what we usually refer to as the “lifestyle”, although being the subject of several studies, up to now has been considered only from a clinical and a statistical viewpoint. However, the construction of a sound mathematical model of the muscle tissue, accounting for the changes due to ageing, can provide a more refined quantitative tool. Such a tool could determine in an improved way the variations of some measurable physiological parameters, such as the mass and the electrical impedance of the tissue, caused by the variation of other controllable factors, such as diet, physical activity, pharmacological treatments, air pollution exposure. A specific mathematical model, once implemented on a computer, makes it possible to perform “virtual” experiments, facilitating the search for a suitable treatment of sarcopenia. Moreover, test situations can be studied which would not be reproducible in vivo, such as drug overdoses, extreme nutritional deficiencies, environmental overexposure to harmful substances, and so on.

One of the biggest challenges for doctors working in chronic care is the correct management of the argumentation phases during the encounters with their patients. During these phases doctors should provide patients with acceptable reasons for being adherent to treatment and for changing certain unhealthy behaviors and lifestyles, something which is particularly difficult for elderly patients, for whom changing life long habits can be extremely hard. However, the medical literature on the subject of communication in the chronic care encounter shows lack of theoretical models and methodological approaches that can highlight which specific linguistic structures or elements in different communication styles favor or impede patient commitment, trust in the relationship and adherence to treatment. The contribution describes ongoing research on argumentative strategies in the encounter with diabetes patients. I describe one recently concluded research project on the argumentation phases of medical encounters in diabetes care, which highlighted critical areas in need of improvement. I also describe the design and aims of a new research project, aimed at testing the effectiveness and usability of certain argumentation schemes in the medical encounter.