Join Professor Andrew Steptoe at this year’s David Hobman Lecture with Age UK to discuss ageing, health and wellbeing.
13 November 2019
How simple policy changes can help us age better and prevent cognitive decline
Many people experience a decline in cognitive function with age, such as a worsening memory and trouble processing information. In most cases, this is perfectly normal. In some cases, however, age-related cognitive decline may affect a person’s ability to carry out complex tasks, such as managing finances or preparing a meal. At times, it may even make it difficult for a person to perform daily tasks, such as dressing and feeding.
But this doesn’t account for the number of people who will experience cognitive decline and dementia as they age. Incidence of dementia sharply rises at the age of 75 – and it is expected that the number of people in the UK living with dementia could triple by 2050. Cognitive function is very important to older people’s well-being. It influences everything they do, including working and socialising, and has a huge social and economic impact on families. Finding ways to prevent cognitive decline is increasingly important.
But recent research by our team found that social and emotional well-being – meaning our feelings of being connected to family and the community, and our subjective experience of positive or negative emotions – may be just as important as therapy and lifestyle for maintaining good cognitive function in older age. Numerous studies from around the world have found that social connectedness and loneliness influence older people’s cognitive function, including their memory.
Loneliness affects approximately 9% of people over 65 in the UK. It’s a complex emotional state where people perceive their social interactions and individual relationships to be inadequate.
One major study on ageing – which collects data from more than 18,000 UK over-50s about physical and mental health, well-being, finances and attitudes towards ageing – found that isolation and loneliness were associated with poorer memory, especially among those with lower levels of education. In addition, loneliness in older age was associated with a steeper decline in cognitive function. This included worse memory and verbal fluency.
Cognitive decline and loneliness
Although these findings are staggering, they also show us how difficult it is to establish if loneliness causes cognitive decline, or if cognitive decline causes loneliness. One way to find out is by looking at whether interventions to reduce loneliness also inadvertently affect older people’s cognitive health too.
We addressed this question in a series of studies looking at the impact that free bus travel had on over-60s. When the UK government gave free bus travel to people over 60 in 2006, it was thought that the measure may reduce loneliness and increase social engagement as it enables older people to remain connected to their social environments.
We found that free bus travel significantly increased public transportation use but, in addition, it led to improvements in cognitive function – particularly, improved memory.
In another study, we found that increased public transportation use also reduced depression and feelings of loneliness. It increased participation in volunteering activities and contact with older people’s adult children and friends. These findings show how a simple policy has had unintended positive consequences. It led to significant improvements in older people’s cognitive function and mental health – potentially by influencing social well-being.
This isn’t the first time we’ve found how social policy changes can help protecting older people against cognitive decline. For example, we examined the impact of a French law that increased the minimum legal school leaving age by 2 years in 1959, from 14 to 16 years of age.
This law effectively increased the years of schooling for French adults presently reaching old age. We found that even decades after leaving school, a longer period in education helped older adults maintain cognitive function – particularly memory – and postponed cognitive decline.
Even policies that affect the whole economy have been found to be an important factor in health and memory. We found that older people exposed to an economic recession in the years leading up to their retirement experience faster cognitive decline in their post-retirement years. This suggests that policies that protect older people from the impact of economic decline might help them to maintain good cognitive function in older age.
Long-term care policies that enable older people to maintain independence and continue to socialise may also be important. “Ageing in place”, an approach that emphasises the importance of supporting older people to continue living in their home and community, has led many governments to offer care for older people with limitations in their own home.
Our research suggests that only a small fraction of older Europeans that have difficulty performing daily activities (such as dressing, walking or washing) are actually eligible to receive home care through the government.
But we also found that an increase in the amount of care that people receive at home through government-sponsored programmes, paradoxically, increases the amount of assistance they receive from friends and family. This suggests that a long-term policy that expands access to home care may help older people maintain social ties, mental well-being, and cognitive function well into older age.
While prospects such as new drugs that protect against cognitive ageing are exciting, research shows that many simple policy changes can also promote social and emotional well-being – which may be just as important for maintaining brain function in later life. Even in the face of declining physical ability, programmes that provide long-term care at home may be critical for maintaining cognitive function and leading a meaningful life at older age.