All the wrinkles on ageing

For 55 years Rayne Stroebel thought he could not draw a stick figure. But on an art retreat this month the professor of dementia studies painted striking watercolours. The point: it is never too late to try something different and, in learning a new skill, help to protect your brain against dementia.

We can train the brain for what we want to do. We all have this potential with the right resources, discipline and practice
— Neurologist Dr Kirti Ranchod

At the 17th conference of the International Federation on Ageing (IFA), held in Africa for the first time this year, neurologist Dr Kirti Ranchod said: “We can train the brain for what we want to do. We all have this potential with the right resources, discipline and practice.”

Up to 45% of all cases of Alzheimer’s can be prevented by modifying 14 lifestyle risk factors and slowing down the progression of dementia, she said. People can, for example, learn how to respond to stress to reduce risk. “Stress has such an impact on brain function and health and increases the risk of illnesses.”

Ranchod is a co-founder of the Africa Brain Health Network (ABHN), an organisation that supports brain health through education, research and community collaboration. Stroebel is also on the ABHN team.

Pan-African values such as ubuntu, harmony and plurality are among the cultural resources that support healthy ageing, said Ranchod, who runs a “brain health solutions” company called Memorability. “Not everything has to be economically valuable to be valuable. Social cohesion, traditional crafts and diets... can support brain health.”

Ranchod and Stroebel, an executive member of the International Longevity Centre, are professors at North-West University (NWU), which co-hosted the conference in Cape Town with the IFA. More than 500 delegates from 63 countries attended the event, which ended on Friday.

Dementia is increasing rapidly in Africa and the Middle East, faster than in other regions of the world, a 2022 report in The Lancet Public Health journal showed.

“Stimulating the brain is the only one of the lifestyle modifications that is pretty novel. This can be different for everybody: for some people it is crosswords and sudoku; for others it is learning a language or music, or cooking or knitting. They are cognitively complex,” Ranchod said in an interview.

So what do the experts do to stay sharp? As a painter, Ranchod enjoys visiting art galleries and does yoga daily. Dr Allison Sekuler, chair in cognitive neuroscience at the University of Toronto and co-host of the Defy Dementia podcast, plays the drums and does improv.

Lifestyle changes involving diet, physical exercise, cognitive challenge and social engagement can protect people at risk of dementia, according to a study published by the Journal of the American Medical Association Network in July.

“The structured interventions had better gains than the self-guided interventions but both groups benefited,” said Dr Hamid Sohrabi, director of the Centre for Healthy Ageing at Murdoch University, Australia, one of the authors of the study.

Dr Amal Wanigatunga, of the Johns Hopkins Center on Ageing and Health, was lead author of a separate study. “Increasing physical activity, even as little as five minutes a day, can reduce dementia risk in older adults,” he said.

Vaccination is “the key driver of healthy ageing” among adults whose immune systems weaken with age, said Prof Jeffrey Mphahlele, deputy vice-chancellor for research and innovation at NWU.

“Vaccinations prevent mortality and morbidity and improve quality of life,” said Mphahlele, who chairs the National Science & Technology Forum. Globally more than 70,000 adults die of vaccine-preventable diseases every year.

The president of the South African Medical Research Council, Prof Ntobeko Ntusi, said: “Flu, pneumonia, shingles, Tdap [tetanus, diphtheria, pertussis] and RSV [respiratory syncytial virus] vaccines are recommended for older adults.” The shingles vaccine can prevent one in five cases of dementia, a study published in the journal Nature in April showed.

Ntusi said it was a concern that 28% of older South Africans express vaccine hesitancy.

Vaccine advocate Laura Tamblyn-Watts, the CEO of a Canadian advocacy programme for seniors, CanAge, said: “One of the biggest drivers [of vaccine uptake] after cost is, ‘What is my neighbour doing?’”

Other affordable and cost-effective programmes — from being in nature to physical activity — also help older people remain healthy longer, and save health-care systems money.

In New Zealand, every dollar invested in a programme called Steady as You Go saved the economy 2.4 times that amount, said Karen Billings-Jensen, the CEO of Age Concern New Zealand.

The simple balance and strength training offered to older people twice a week had five positive results, including reducing falls and emergency department visits and boosting social connections. “We’ve got people who have been doing the programme once a week for 20 years. It increases confidence and reduces loneliness,” Billings-Jensen said.

The vital role that peer support plays in healthy ageing was a standout theme at the IFA conference. “If I could package peer support, it would be a blockbuster drug,” said Dr Leon Geffen, an honorary senior lecturer at UCT's Institute of Ageing in Africa.

“The big move in geriatrics is to deprescribe [medication],” he said, advocating “social prescribing” to advance connection and community.

Prof Nicola Ann Plastow, head of occupational therapy (OT) at Stellenbosch University, described a social programme in the impoverished community of Bishop Lavis, on the Cape Flats, which improves wellbeing.

Prof Jeffrey Mphahlele, deputy vice-chancellor of North-West University, stressed the role of vaccines in healthy ageing. (Claire Keeton)

Every year about 60 older people decide what they need and co-design a programme with OT students, she said. They chose “wellness Wednesdays” with fitness activities and trauma counselling, a social calendar on Thursdays — including quizzes, board games and theme days like rock ’n roll — and one-on-one rehabilitation sessions.

“These kinds of small projects can have an exponential impact for people who have been restricted to one geographical location,” she said.

Nearly 1,000 people have joined group activities and 148 have received individual treatment over three years, said Plastow.

Hearing loss is the No 1 modifiable risk for dementia, many speakers said.

“Hearing loss is a silent epidemic,” said University of Pretoria audiologist De Wet Swanepoel, noting that 80% of those affected live in lower- and middle-income countries.

“The negative impacts include social isolation, increased risk of cognitive decline and of falls.”

Health-care workers using digital technology and supported remotely by hearing experts could screen for hearing loss and provide preset hearing devices for those who need them, said Swanepoel. He quoted one overjoyed woman who had received a hearing aid as saying: “Now I can go to church again.”

Kgosietsile Sehularo, chair of the South African Older Persons' Forum, told the IFA event that the elderly fear being “invisible, silent and left behind” — their position is, “nothing about us without us”.

Older women, particularly, need to be empowered, said conference panellists. Besides “invisibilisation”, they suffer structural injustice. Only 56 countries offered older women universal access to pensions and in more than half the countries of the world they do not have land ownership rights, the panellists said.

Yet older women are the foundation of caring systems and the informal economy in many societies, especially where traditional family structures are being eroded, speakers said.

In Hangberg, Hout Bay older women raise their grandchildren, said Stroebel, who did his doctoral research on dementia in the impoverished community.

“This is a community where older people are 100% involved and engaged. They are the givers of care, not the recipients of care,” he said. “The biggest modifiable risk factor against dementia is retirement,” Stroebel said. “We create retirement communities around the world where rich people go ... and do not have to lift a finger, and this is disabling.”

Stroebel, MD of Geratec, a private company offering services to retirement communities and care homes, is the South African representative of the Eden Alternative, an initiative to transform aged care by bringing plants, animals and children into institutional settings.

IFA secretary-general Gregor Sneddon said the conference was not only about healthy ageing but also about healthy societies, saying: “Healthy ageing is not just about preventing disease but about creating an ecosystem where people of all ages can thrive and have a life of dignity, belonging and wellbeing.”