Inaugural lecture David van Bodegom: Vitality in an ageing population

Inaugural lecture David van Bodegom: Vitality in an ageing population

On November 11, 2021, our colleague David van Bodegom delivered his inaugural lecture as professor of ‘Vitality in an ageing population’ at the Leiden University Medical Center, Department of Public Health and Primary Care. The chair was established by Leyden Academy.

Healthy ageing
According to David, the key to healthy and vital ageing lies in our living environment. He therefore argues in favour of changing our living environment in the fight against lifestyle-related disorders instead of making individual citizens feel guilty. “So-called ‘aging diseases’ such as type 2 diabetes, obesity and cardiovascular disease are a huge problem in the Netherlands. While they can partly be prevented or remedied with a healthy lifestyle,” says David. But in an environment where we sit in our office for hours and have access to unhealthy food at any time of the day, healthy behaviour is difficult to maintain, according to David. “Our environment makes us sick, so we have to deal with that.”

The environment guides choices
David illustrates by means of a personal example that the offer in the environment guides our choices. “Since there is a bowl of apples next to the coffee machine at work, I eat a lot more apples. Not because I want to or because someone told me to, but simply because it’s there. So if we change our environment, our behaviour will follow naturally. In this way it is more pleasant and more promising to maintain a healthy lifestyle.”

Beyond the consulting room
Healthcare is just not geared up for this yet, David notes. “Prescribing medicines pays more in the current system than discussing a healthy lifestyle with the patient.” Fortunately, he sees that there is a movement in this area. “I notice especially among young doctors and medical students that lifestyle is becoming increasingly important. They look beyond the consulting room.” The National Prevention Agreement and the inclusion of combined lifestyle interventions in the basic healthcare package are also steps in the right direction, according to the professor. “But we have not won the battle yet.”

Peer coaching
To promote the vitality of older persons, David and colleagues at Leyden Academy founded the Vitality Club. These are groups of older neighbours who exercise together a few times a week, entirely on their own initiative and therefore without professional supervision. “These clubs are a great success. Participants come to participate for their health, but keep coming back for the fun. This shows that the social aspect is important. The elderly coach each other to stay healthy.” The next step is to investigate whether this form of peer coaching also works for people with type 2 diabetes. In an initiative in Leiden a lifestyle program was recently set up for this purpose. “We are going to investigate whether such an alternative referral process can yield health benefits and can relieve the burden on healthcare in a sustainable way.”

Health gain
In the coming years, David and his colleagues want to take the movement in lifestyle medicine even further. “There is still much to be gained in health for older persons. To make this happen, we need to shift our focus from the individual to the population.”

Rudi Westendorp: “Danes keep to the agreements”

Rudi Westendorp: “Danes keep to the agreements”

How does healthcare work in Denmark, what does it cost and how has the Danish healthcare system withstood the ‘stress test’ of the COVID pandemic, compared to the Netherlands? Rudi Westendorp, professor of Geriatric Medicine at the University of Copenhagen and member of the Danish Outbreak Management Team, discussed this with the students and alumni of our executive course ‘Good life, good care for the elderly’ on 15 October 2021.

About thirty administrators and policy makers from (elderly) care were gathered in the Faculty Club of Leiden University. The annual study trip to Scandinavia could not take place due to the corona measures, so Professor Westendorp was asked to place Dutch healthcare in an international perspective. The former director of Leyden Academy, who has been working and living in Copenhagen since 2015, made it immediately clear that Danish care is organized very efficiently: he showed his personal pass, were caregivers provide all necessary information and which gives him access to care everywhere.

Make sure to dream
The Danish healthcare system is equally efficient in its management. The country is divided into five regions with one director above them, with the power to persevere. There is one centrally controlled GGD. Long-term care is provided by the 96 municipalities, which are given a lot of freedom to fulfil their task transparently and following the quality requirements. Very logical, Westendorp thinks, also for the Netherlands: “In Rotterdam you need something different than in East Groningen”. Healthcare costs are lower in Denmark (approximately 12% of GDP compared to more than 14% in the Netherlands) and the population benefits: Danes give their lives an average of 8 and this rating increases as people get older. Westendorp: “This is actually the care we dream of in the Netherlands… but which we will never get.”

Corona as a stress test
You can also measure the quality of a care system by the extent to which it is shock-resistant. Westendorp calls the COVID pandemic a ‘stress test’. And here too, according to him, Denmark performs better. The ICs coped well with the rush and there is no delayed care. Nor has there been any excess mortality in Denmark; Neighbouring Norway even records under-mortality, because influenza barely got a foothold there due to the corona measures. How is it that COVID in the Netherlands has claimed so many more victims among the older population? Food for thought, according to Westendorp.

A deal is a deal
Various causes were suggested from the discussions at the tables. Are the Danes healthier than us? No, says Westendorp, “they smoke and drink like heretics”. Is it because the country is less populated? Nonsense: one in three Danes lives in Copenhagen, an urban area with 2 million people. The professor eventually relieved the audience of the tension: it is mainly due to the discipline of sticking to measures. Don’t be under any illusions, there was a lot of heated debate in Denmark too. But if 80% of Danes agree on the right way, then that’s the decision, and the other 20% also agree. Westendorp: “The Dutch often think: ‘I’ll decide for myself’. Danes keep to the agreements, and people won’t deviate from this. So there are no implementation problems.”

We before me
This is also the main reason for Westendorp’s conclusion that we will never receive the “dreamed” Danish care in the Netherlands. A deal is a deal and we before me, that is simply ingrained in the Danish national character and not in ours. Danes wore face masks en masse because you don’t have to think about infecting someone else. The Dutch wore the masks reluctantly, mainly to protect themselves. It elicits Westendorp’s statement that “every country gets the COVID epidemic as an expression of the culture that prevails there”.  Yet there is hope, because, according to the professor, both countries share the collective will to properly arrange health care and to help each other in times of disaster and misery. “We essentially want the same thing, only we have lost our way in the implementation in the Netherlands. Why the market forces and fragmentation, why don’t we organize it as a public matter?” Westendorp wonders. To end on a positive note: “We can rebuild this and hold government accountable from the bottom up.”

Research on the impact of art on older people

Research on the impact of art on older people

What is the impact of arts engagement on the quality of life of older people? Together with Amsterdam UMC and supported by ZonMw, we conducted a 2-year research project. We recently published our findings in a special issue of scientific journal International Journal of Environmental Research and Public Health. Please click here for the open access article ‘The Value of Active Arts Engagement on Health and Well-Being of Older Adults: A Nation-Wide Participatory Study’.

An emerging body of research indicates that active arts engagement can enhance older adults’ health and experienced well-being, but scientific evidence is still fragmented. There is a research gap in understanding arts engagement grounded in a multidimensional conceptualization of the value of health and well-being from older participants’ perspectives. This Dutch nation-wide study aimed to explore the broader value of arts engagement on older people’s perceived health and well-being in 18 participatory arts-based projects (dance, music, singing, theater, visual arts, video, and spoken word) for community-dwelling older adults and those living in long term care facilities. In this study, we followed a participatory design with narrative- and arts-based inquiry. We gathered micro-narratives from older people and their (in)formal caregivers (n = 470).

The findings demonstrate that arts engagement, according to participants, resulted in (1) positive feelings, (2) personal and artistic growth, and (3) increased meaningful social interactions. This study concludes that art-based practices promote older people’s experienced well-being and increase the quality of life of older people. This study emphasizes the intrinsic value of arts engagement and has implications for research and evaluation of arts engagement.

The article ‘The Value of Active Arts Engagement on Health and Well-Being of Older Adults: A Nation-Wide Participatory Study’ by Barbara de Groot, Lieke de Kock, Yosheng Liu, Christine Dedding, Janine Schrijver, Truus Teunissen, Margo van Hartingsveldt, Jan Menderink, Yvonne Lengams, Jolanda Lindenberg, and Tineke Abma was published in Augustus 2021 in the International Journal of Environmental Research and Public Health.

For more information, please contact Lieke de Kock or visit the project website www.kunstindezorg.com.

Wanted: older dance talents

Wanted: older dance talents

Dancing is not only good for body and mind, but also for the mind. This applies to the young and old. Yet dancing young people dominate social media such as TikTok and Instagram. With the initiative ‘Danstalent’, Leyden Academy and the Jo Visser fund want to show what the older generation has to offer. They also have ‘signature moves’ and can encourage young people to imitate them.

Elderly people and their favourite dance step
We are looking for elderly people who show their favourite dance step in a short, simple video (recorded with a mobile phone). This can vary from salsa, ballet, modern dance, waltz and tango to hip hop, rock & roll, wheelchair dance, line dance and tap dance. We are also curious about the story behind it. What exactly does that dance mean for that person? What is their favourite memory of that dance? From the entries we will make a selection that will be professionally filmed.

Dance challenge for young people
We will then distribute the professional videos via social media, challenging young people to imitate the moves. With this initiative, we want to bring the talents of the old and young together and positively colour the image of older people. Dance talent connects to the public debate about the elderly and their options, following the Dutch public campaign ‘The value of aging’. The Danstalent videos will kick off a symposium in January 2022, where the results of Anna Carapellotti’s research into the effects of dance interventions will also be presented. Anna conducted her research at the inclusive dance program ReDiscoverMe, where professional dancers create dance performances together with people with disabilities.

Are you or do you know a 55+ dance lover? You can e-mail the dance video (max. 3 minutes) to Jacqueline Leijs (leijs@leydenacademy.nl) until Monday 11 October. Please include your name and age and briefly indicate what this dance means to you.

Looking for the new Leyden Academy portrait

Looking for the new Leyden Academy portrait

Each year, alternatingly the portrait of a vital older man or woman is selected to represent Leyden Academy on communication outings (e.g. for website, brochures, banners etc.). For this year, from 11-11-2021 through 11-11-2022, we are looking for an older man (75+) who radiates joy and a lust for life.

Procedure

  • Send us a nice portrait photo with a brief introduction of the person involved (background, life motto, hobbies, etc.).
  • Feel free to submit several photos of multiple persons.
  • The management and communication department at Leyden Academy will select the ‘winning’ portrait.
  • Photos can be submitted up to 27 September 2021 to Yvonne Schinkel-Koemans at koemans@leydenacademy.nl.
  • The picture is royalty-free and will be used by Leyden Academy.
Stereotypical approach to elderly migrants does not do justice to diversity

Stereotypical approach to elderly migrants does not do justice to diversity

The specific cultural background of elderly people with a migration background does not appear to determine their care wishes and needs. The mutual diversity is great, which means that wishes and needs are very personal and partly depend on where and how someone has lived. Migrant elderly also experience problems with obtaining formal basic care and its quality. Nina Conkova (Leyden Academy on Vitality and Ageing) and Marina Jonkers (Knowledge Center for Healthcare Innovation, Rotterdam University of Applied Sciences) were interviewed on this matter by Movisie, a Dutch knowledge institute for a coherent approach to social issues.

Every person is different
The one-sided stereotypical image of older migrants – on which policy is still being made – is incorrect, according to the above mentioned researchers. This also applies to care for the elderly, where it is still often assumed that culture-specific facilities are much better for elderly people with a migration background, because this would take more into account their specific wishes and needs. Nina: “We saw, on the other hand, that too much is being based on uniformity and stereotypical assumptions, while the group of elderly people is very diverse. This in turn leads to unrealistic expectations about specific care for father or mother, which is not there. It simply remains a Dutch setting with a few culture-specific adjustments, such as halal food or a room that is decorated differently. And that doesn’t work. It is about personal attention and customization. Every person is different.”

Sushi in the nursing home
The article is illustrated by striking examples and striking statements. Such as the Moroccan Muslim who indicated that he would later like to be able to continue practicing his religious habits in a nursing home, but would also like to eat sushi. Or the Turkish gentleman with dementia who visited a culture-specific daytime activity where people were divided into groups according to nationality. The man was assigned to the Turkish group, but always went for a walk to the elderly who were born in the Netherlands. He turned out to have been the owner of a nightclub and had always lived among the people of Rotterdam. A wise lesson for the coordinator of the daytime activities, who from now on asks further during the intake about how someone’s life was and what someone likes are.

Click here for the Dutch article.

Scientific evidence for value of art in care

Scientific evidence for value of art in care

A large-scale participation study into art in care in the Netherlands shows that art brings pleasure, positivity and deep contact, and that it challenges, according to the older persons, artists and care workers involved. Leyden Academy on Vitality and Ageing and Amsterdam University Medical Centre provide a solid scientific basis and thus strengthen the place of art within healthcare practice and contribute to the quality of life of the older persons.

“With this scientific basis, we are even stronger in our shared ambition to make art and culture an integral part of the range of care, support and welfare.” – The director of research funder ZonMw

Fun, deep contact and challenge
The study mainly looked at the value of art activities such as dance, drawing, music, singing, poetry, theatre and visual education in long-term care for the elderly. The research team collected 470 stories from older people participating in existing art initiatives and programs and carried out 40 observations. Professor Tineke Abma from Leyden Academy: “This study shows that art and creativity in healthcare can be very valuable: to be able to express yourself, to feel connected to others, to forget your limitations for a while and to be approached from what you can still do. In addition to this feedback from the participants, the care workers, informal carers and artists also emphasize the value of the activities for themselves. They experience pleasure, deep contact and are challenged in their profession.”

“Only afterwards did I hear that this had helped one of the participants to come out of the dejection. Those afternoons meant so much to them. It gave them something completely different to focus on.” – Theatre maker

Art in times of corona
The restrictions imposed by the corona pandemic and the associated measures quickly changed the course of the research project. Nevertheless, the artists provided an alternative, but equally valuable, interpretation to the activities within the various programs and initiatives. Because in this difficult time, the participants needed the  distraction, inspiration, comfort and contact even more.

“Now with corona, people experience a lot of problems. Reason enough to need a psychiatrist or a psychologist. But I think a blanc canvas, brushes and paint will be more effective.” – Participant in one of the art initiatives

Sustainability
The research project ties in with the worldwide movement for more art in healthcare, supported by the World Health Organisation. In healthcare there is a need for creativity, to colour outside the lines, to support the enthusiasm of employees and to work in a demand-oriented way. In the social domain, there is a demand for promoting participation and connection between citizens, and the cultural sector wants more connection with society. Participatory art can play a role in this! All this requires better cooperation between the government, municipal officials, funds, administrators in care and welfare, project leaders and artists.

Click here for the Dutch publication.

Growing old with health and vitality

Growing old with health and vitality

Is there a miracle cure for growing old with health and vitality? In a PEP talk, David van Bodegom, aging scientist at Leyden Academy on Vitality and Ageing and professor of Vitality at Leiden University Medical Centre, talks about the influence of moving more and sitting less still during normal daily activities. In addition, the environment you live in has a major impact on how healthy you stay.

Healthier lifestyle
Van Bodegom gained his insights during years of fieldwork in rural Ghana. In that country, age-related diseases such as diabetes and cardiovascular disease are rare. Because of their lifestyle, Ghanaians often grow old in a healthier way than people in the Netherlands. David explains why in this PEP talk video (in Dutch).

Our environment
Van Bodegom and Rudi Westendorp (University of Copenhagen) have bundled their most important insights about aging, health and vitality in a Dutch book (translated into ’10 years extra. A new approach to living healthier for longer’). Is it really possible to give yourself ten extra healthy years of life, as the title of this book suggests? Yes, according to the authors, who claim the key to this lies in our environment.

Towards a healthy daily routine
In the book various environments from everyday life are discussed, such as the kitchen, living room, bedroom, supermarket, work and the neighbourhood. Don’t expect raised fingers; this approach is based on seduction rather than prohibition. By surrounding yourself with smart and healthy choices, a better lifestyle can unnoticed become part of your daily routine. Swap large wine glasses for small ones, walk to the supermarket and use a backpack, walk or cycle a part of your daily commute. All these small adjustments, repeated over and over, add up to a large and lasting effect.

Four words
Van Bodegom and Westendorp introduce the readers to four leading words. The first strategy is that of ‘remove’: put unhealthy stimuli out of sight. So don’t store cookies in a glass jar but in a closed drum, and don’t put it on the coffee table but in a kitchen cupboard. That way you won’t always be tempted to grab another one. You can also ‘replace’: exchange those cookies for unroasted nuts. And place a bowl of carrots at eye level in the fridge where the cream puffs are normally located. In public spaces it is more difficult to remove or replace temptations, here it is better to ‘avoid’: if you know that you always give in to a cheese croissant at the bakery, then walk around the block. Or you ‘prepare’: eat a banana and drink a bottle of water before you go to that reception. Then you can better resist the tempting snacks and dr, wine and beer.

The added value of a course on entrepreneurship for older people

The added value of a course on entrepreneurship for older people

In July 2021 Julia Heidstra successfully completed her MSc Vitality & Ageing in Leiden. The subject of her thesis was the impact on the wellbeing of older persons who participated in Silver Starters, an intensive online course on entrepreneurship which ran from January to March 2021 and was developed and organised by Leyden Academy and Aegon. Julia’s research found that these ‘olderpreneurs’ gained on eudaimonic wellbeing, and that it enabled them to flourish even more.

Eudaimonic wellbeing
There is a trend from welfare towards wellbeing when it comes to evaluating how successful populations are at managing health. Eudaimonic wellbeing is associated with mental health and is linked to physical health. Improving eudaimonic wellbeing can thus be useful in increasing population health. Leyden Academy has been at the forefront of stimulating focal areas of eudaimonic wellbeing: meaningfulness, connectedness and vitality. One of our recent interventions is Silver Starters. It has been shown that societal engagement, such as volunteer work or later life employment contributes to purpose in life and meaningfulness.

About Silver Starters
In this free-of-charge, personal learning program people aged 50+ learn the basics to turn their idea into their own business in several modules of online learning and personal coaching by experts. Almost 100 ‘olderpreneurs’ participated in the course, working on start-up ideas ranging from lung function testing, virtual reality learning applications to improving self-sufficiency of agricultural products in Curaçao. Whilst it is too early to judge whether any of these start-up ideas will actually grow into (internationally) listed ventures, research carried out by Julia on the impact of the course showed additional benefits to the participants.

Research method and question
Julia used qualitative and quantitative measures. Respondents (N=40), completed Diener’s Satisfaction With Life Scale and a single question about whether participants found that the course had impacted their wellbeing and answers were recorded on a Likert-like scale. Furthermore, in-depth interviews were then conducted (N=10) to investigate the impact from the participants’ perspectives. The following questions guided this impact research:

  • Did participation in Silver Starters have an impact on the individual’s wellbeing?
  • How did participants evaluate this wellbeing?
  • How did participants feel that Silver Starters provided them with a tool to achieve eudaimonic outcomes in the future?

Outcome
Participants reported high levels of wellbeing that was even more positively impacted by participating in Silver Starters. One of the reasons of these high levels of wellbeing were the proactive coping strategies participants demonstrated. Such coping strategies focused on personal growth and adaptation, for instance reflecting on experiences, seeking learning opportunities and putting things in perspective. Feelings of connectedness and meaningfulness were associated with vitality. This indicates that Silver Starters not only provided entrepreneurial skills, it also enabled flourishing. These findings suggest that a course in entrepreneurship can add so much more to society than economic values and that it can even help in managing population health.

You can always start again but there’s always something that can go wrong. I thought, I need a better foundation, how it is done, because at school you only learn useless things, formulas and French and things you’ll never need. You don’t learn about life. Entrepreneurship is, that is a lot closer to life than all the knowledge you have to learn.’ – 57-year-old participant

Click here to read Julia’s thesis.

Publication Global Reflections on COVID-19 and Urban Inequalities

Publication Global Reflections on COVID-19 and Urban Inequalities

In July 2021, the publication Global Reflections on COVID-19 and Urban Inequalities was published by Bristol University Press. This four-part collection includes volumes on Community and Society; Housing and Home; Public Space and Mobility; and Policy and Planning, and explores the impact of the COVID-19 pandemic on (inequities in) society and people’s lives.

The first volume, edited by Brian Doucet, Pierre Filion (University of Waterloo, Ontario, Canada) and Rianne van Melik (Radboud University), centers on Community and Society, and includes the article ‘Following the Voices of Older Adults During the COVID-19 Crisis: Perspectives from the Netherlands’, by Leyden Academy authors Jolanda Lindenberg, Paul van de Vijver, Lieke de Kock, David van Bodegom, and Niels Bartels. In this article, we share the experiences of older people in the Netherlands through the eyes of Mbarek, Joke, Wim, and Maria, who previously shared their personal stories on our platform We & corona. We also share findings from our qualitative research into the experiences of older people in times of COVID-19.

In addition to the perspective of older people, the impact of the pandemic is also discussed in this edition from the point of view of people who live below the poverty line, (labour) migrants, transgenders and people with a visual impairment. Contributions come from all over the world: from Jamaica to Turkey, and from New Zealand to Vietnam.

You can order the publication through Bristol University Press as hardcover (GBP 36,00) and ebook (GBP 10,39).

For more information on our qualitative research into the quality of life of older people during the COVID-19 pandemic, please click here.