Exploring psychologies of ageing

Three universities, Worcester, Keele and Aston, came together between May 2015 and February 2016 to explore psychologies of ageing: the range of social, critical, cognitive, biological and community psychology perspectives adopted when researchers and practitioners focus on the topic.

The first seminar of the series, hosted by the Association for Dementia Studies at the University of Worcester, discussed 'Ageing in Context: Identities and Diversities' with delegates including academics, healthcare workers and service users. Social research, recognising diversity in ageing across genders, sexualities, illnesses, contexts and lifespan trajectories (e.g. Peel & Harding, 2016), was to the fore. What does a recognition of different identities mean for ageing well? And how does psychology, health and social care best engage with identities and diversity within an ageing population?

Professor Dawn Brooker, Director of the Association for Dementia Studies, opened with a talk focused on maintaining personhood in advanced dementia through understandings of identity. She discussed the policy narrative around dementia, which has shifted from one that positioned dementia as 'the death that leaves the body behind' to notions of 'living well with dementia'. Bringing person-centred dementia care approaches alive through vivid personal illustrations based on life- story work, Brooker highlighted the importance of cohort effects in maintaining personhood, identity and sense of self (Brooker & Latham, 2015).

The second speaker was Christine Bryden, a key figure in the dementia self-advocacy movement (Bryden, 2015) who was diagnosed with younger onset dementia in 1995. She discussed her perspective on receiving a 'toxic dementia prescription' – a diagnosis that communicated hopelessness and helplessness. The moving talk offered a framework for those with dementia to find meaning, highlighting the key components of identity, connectedness, security, autonomy, meaning, growth and joy.

The final speaker, Professor Sue Wilkinson, discussed the challenge of identity in making advance decisions to refuse treatment (AD: see also the December 2015 issue). One in three of us will lose 'mental capacity' by the end of our lives: ADs allow an individual to make decisions about future health care in advance of that. Professor Wilkinson focused on the challenges to personal identity posed by chronic disorders of consciousness, and by dementia, around issues of biographical continuity and rupture. She also discussed how a particular notion of identity is not universally shared, and how the concept may be shaped by, for example, gender, sexuality, ethnicity and religion.

As well as smaller group discussion there were 10 poster presentations addressing many different diversity and identity issues impacting older people, such as lesbian, gay, bisexual and trans issues in dementia, visual impairment and intergenerational practice. For instance, Daniel Herron's research at Keele focused on understanding the subjective experiences of people with learning disabilities and dementia, and Jennifer Bray and Karan Jutlla's research at Worcester considered awareness of dementia in black and ethnic minority communities. Taken together, this first seminar foregrounded chronic and long-term conditions that disproportionately affect older people, while moving beyond a traditional emphasis on the ageing individual, to explore the relational and social contexts of dementia care and end-of-life decision making. 

The second seminar, hosted by the Aston Research Centre for Healthy Ageing, focused on 'Positive Ageing: Lifestyles and Living Well'. How do active or 'healthy' environments interact with personal variables such as coping styles, cognitive health, mobility and co-morbidities? The seminar examined the underlying issue of whether positive ageing and prevention of frailty, cognitive decline and dependency is all about reducing illness risk and neuropathies.

Dr Anne Hendry, National Clinical Lead for Integrated Care from NHS Scotland, provided the first talk. She discussed initiatives implemented via a plan for active and healthy ageing, in particular the Reshaping Care for Older People programme. This was underpinned by an ambitious shift towards more preventative, anticipatory and coordinated care and support at home, delivered with local people and communities. A key thread throughout the day, and emphasised in this opening talk, was the malleability of frailty and the potentials for reversibility, leading to concepts of anticipatory care, prevention strategies and lifestyle issues such as physical movement and exercise (see tinyurl.com/h3hlr4s).

Next up was Dr Anna Phillips (University of Birmingham), who examined the impacts of stress on health in older age. Stress and depression can worsen immunity, particularly among older adults, as illustrated by the varying response to vaccination or in wound healing, for example after surgery. Caregiving was highlighted as a source of chronic stress that has increased detrimental effects when combined with increased age. Dr Phillips outlined both positive and negative psychological and social factors that can boost or harm immunity, and she demonstrated that being even just a little more physically active can result in a positive response (Heaney et al., 2014).

Dr Sarah Bauermeister (University of Leeds) then discussed experimental research focused on cognitive variability and physical predictors of falls in older adults. Certain physical measures, such as poor grip strength, impaired balance or gait speed, are associated with falls. Focusing on more psychological measures, Bauermeister reported on her findings that deficits in executive function and greater 'cognitive variability' – the variation in trial to trial (or moment to moment) reaction time for a single person in a given cognitive task – were associated with a higher likelihood of falling. However, we were again shown evidence that both the physical and cognitive predictors of falls can be positively affected by physical fitness and activity intervention (Bauermeister & Bunce, 2014).

The last speaker was Professor Eef Hogervorst (Loughborough University), who discussed the healthy lifestyle issues that can reduce dementia incidence. For example, she illustrated the dementia risk factors such as obesity, diabetes and high cholesterol that we may be familiar with, but also issues such as poor oral health and periodontitis. Hogervorst discussed current interest in the '5:2' concept, whereby people eat far fewer calories than normal for two days in each week, suggesting its positive effect on insulin control. The links between diet and exercise were discussed, with resistance exercise being positively supported in terms of links with cognition (e.g. see Hogervorst et al., 2012). Hogervorst also led a 'cooking for cognition' practical workshop, which demonstrated how combining some of the ingredients that have been associated with a reduced dementia risk (e.g. turmeric, olive oil and tempe) can be used in tasty meals (e.g. Soni et al., 2015). A concurrent workshop, facilitated by Maria Parsons of the Creative Dementia Arts Network Oxford, explored using creative arts to maintain the health and wellbeing of people with dementia: activities such as singing, dancing, reciting poetry or taking photos can help when words begin to fail us.

At the 'Lifestyles and Living Well' seminar, poster presentations included Emma Broome's PhD research at the University of Nottingham looking at factors that enable high-quality arts programmes in care homes, and two presentations on mild cognitive impairment from Heather Yemm at Worcester and Danielle Clarkesmith and colleagues at Aston. ARCHA research on autobiographical memory training, older drivers' behaviour, rehabilitating word-finding difficulties, assisted living, and mobile diet diary app use also featured.

The final seminar, hosted by the Keele Initiative on Ageing, spotlighted 'Ageing in Place: Independence and Communities'. This seminar explored ways of enhancing community participation among older people, and involved delegates from local authorities, housing agencies, community organisations and advocacy groups. Many older people have lived in their neighbourhoods for a large part of their lives, yet social exclusion from social and civic activities can negatively impact people as they age. The first speaker, Guy Robertson from Positive Ageing Associates, overviewed some emotional and psychological aspects of 'positive ageing' (Robertson, 2014). His interactive talk also focused on dispelling harmful 'myths' about ageing.

Older people's sense of self is strongly rooted in place. In the second talk, Professor Judith Sixsmith (Northampton University) described how on the one hand, the provision of home and community supports can enable people to successfully 'age in place' by improving physical and mental health, supporting social participation and enhancing independence; on the other hand, ageing in place can be an ideal forced on older people who are not fully integrated into the development, content and delivery of place-based supports. Using the case study of a community-based participatory research approach with low-income minority ethnic older people in British Columbia who were being re-homed by a non-profit housing provider, she emphasised the 'brokering' role of academics in building community partnerships, and developing shared interests and common goals, which then generate synergistic outcomes. By detailing the methodology (which included experiential walks with residents wearing 'GoPro' cameras) she demonstrated how research can be used to co-create meaningful housing solutions for older people transitioning into affordable housing.

Next up was Swansea University's Dr Charles Musselwhite, who explored auto-mobility, community connections and independence in later life. Drawing on a critical gerontological perspective, he discussed his research on older people giving up driving. Contrary to the notion that people's health and wellbeing deteriorate when they give-up driving, Dr Musselwhite found that older people can successfully give up driving with little or no ill effects. In part, he suggested, this is due to informal support networks and availability of services and shops, but moving beyond 'auto-mobility' is also due to changes in perception about different modes of transport and changing where activities are located. He also suggested that car-linked independence was a misnomer, and that the affective and interdependent aspects of travels are important in this context.

The seminar series was rounded-off with a talk from Paul McGarry (Manchester City Council) about the policy, practical, and fiscal challenges in building an age-friendly city. He situated the Manchester case study in a national UK context which, since 2010, has not had a national ageing strategy. Through the development of an age-friendly city network, innovative partnership working has attempted to 'age-proof' universal services and promote innovative local initiatives such as the 'Valuing Older People Cultural Offer' in Manchester. McGarry discussed strategies for engaging people in times of austerity and budgetary cuts, and the advantage of applying an 'ageing lens' to services and city infrastructure. Establishing an 'age-friendly night club' in Manchester was symbolic of many of the initiatives he discussed to engender interdependence and community for those in later life.

Poster presentations at this final seminar included the effects of reading poetry (Richard Seymour, Keele), empowering older people in care settings (Peter Kevern, Staffordshire), structured autobiographical memory (Fiona Leahy, Aston) and intergenerational practice (Katie Wright-Bevans, Keele). There was also a display of some of the work from the New Dynamics of Ageing research programme (Beech & Murray, 2013).There were numerous suggestions from those involved in the seminar series about future events, including isolation, ageist language, psychological interventions for dementia, involving older people in research, and facilitating the move from research to practice. Two hundred people were involved in this BPS-supported seminar series, we hope the conversation continues.

References
Bauermeister, S. & Bunce, D. (2014). Aerobic fitness and intraindividual reaction time variability in middle and old age. Journals of Gerontology Series B: Psychological Sciences and Social Sciences. doi:10.1093/geronb/gbu152
Beech, R. & Murray, M. (2013). Social engagement and healthy ageing in disadvantaged communities. Quality in Ageing and Older Adults, 14, 12–24. 
Brooker, D. & Latham, I. (2015). Person-centred dementia care (2nd edn). London: Jessica Kingsley.
Bryden, C. (2015). Nothing about us without us: 20 years of dementia advocacy. London: Jessica Kingsley.
Heaney, J.L.J., Carroll, D. & Phillips, A.C. (2014). Physical activity, life events stress, cortisol, and DHEA in older adults. Journal of Aging and Physical Activity, 22, 465–473.
Hogervorst, E., Clifford, A., Stock, J. et al. (2012). Exercise to prevent cognitive decline and Alzheimer's disease. Journal of Alzheimer's Disease & Parkinsonism, 2, e117. 
Peel, E. & Harding, R. (Eds.) (2016). Ageing and sexualities: Interdisciplinary perspective. Farnham: Ashgate. 
Roberston, G. (2014). How to age positively. Bristol: Positive Ageing Associates.
Soni, M., White, L.R., Kridawati, A. et al. (2015). Phytoestrogen consumption and risk for cognitive decline and dementia. Journal of Steroid Biochemistry and Molecular Biology. doi:10.1016/j.jsbmb.2015.10.024