Targeting retirement communities for health promotion and osteoporosis prevention

Dr Clive Bowman

Targeting retirement communities for health promotion and osteoporosis prevention

Health and social care systems across Europe are already under significant strain, though the ageing and future population projections make it clear that any action to enhance wellbeing must be on the agenda. As we enter the World Health Organization’s Decade of Healthy Ageing, promoting the prevention of avoidable declines in health and quality of life must be a key objective. One area for renewed preventive action is osteoporosis – and, by association, the fragility-related fractures caused by the disease’s weakening of bones.

In 2010, there were 27.5 million people with osteoporosis in the EU and nearly 10,000 fragility fractures every day.1 By 2025, the number of Europeans with osteoporosis is estimated to reach nearly 34 million, costing EU countries approximately €120 billion.1

We know that identifying people at high risk of fragility fractures and offering support such as promoting positive lifestyle changes, sometimes with additional medical treatment, can help prevent costly and debilitating fractures from occurring in the first place.2 The earlier that we can identify people at high risk, the more successful we can be in preventing fractures.

Currently there is a tendency to look towards care homes as an opportunity to engage with vulnerable people during their transition to full-time care. Sadly, this is almost certainly too late in the life course for effective intervention for bone health – though, undoubtedly, exercise is often very helpful in maintaining function. Targeted treatments for osteoporosis prevention are best considered a long-term investment in wellbeing, and may be difficult to take up at this later stage of life when horizons may be often less than a year or two.

Clearly, the attraction of care home residents as a population is that they are readily identifiable – but there are other life transitional windows that warrant consideration.

Seizing the moment of transition

Most people transitioning to a care home do so with reluctance and at short notice, at a point where the burden of long-term conditions – often brought to a crisis by an acute illness – has left little alternative to full-time care. However, the decision to move into a retirement community (sometimes also known as retirement homes, senior housing or supported housing) is generally quite different. Retirees will typically plan and make a deliberate choice about this relocation. Such a move will often have a number of drivers, such bereavement or economic stress, but may also be influenced by positive draws such as the increased social opportunities of a retirement community, the financial freedom of downsizing from a large home and, crucially, a desire to extend independent living and wellbeing.

Fundamentally, moving into a retirement community is a moment when a person is making a conscious choice about their future. This is a moment when they may be more sensitive and receptive to advice and, furthermore, have the independence and physical ability to act on it. This moment of transition could be a prime window to get people thinking about the lifestyle changes they may need in order to maintain their bone health before a fracture limits their quality of life.

By targeting this group of people for information on or screening for osteoporosis, we are selecting a group who is already thinking not only about where they want to live, but how they want to live.

There are many types of retirement communities throughout Europe.3 With demographic shifts, added pressures on existing social support and a rise in poverty among people over 65, retirement homes are sure to rise in demand in the coming years. In the United Kingdom, for example, the Centre for Ageing Better has reported that 16% of people aged over 65 live in relative poverty.4 This is going to put significant pressure on retirees’ abilities to afford their own homes, leading in turn to high demand for social housing. Retirement communities can be expected to help meet the demand for lower-cost housing, both for people from lower socioeconomic groups and for wealthier people who are looking to reduce their living expenses in order to release funds to enjoy their retirement.

Prevention to meet the risk and opportunity

The interventions that may be appropriate for retirement communities will vary. It seems quite unrealistic to have each resident undergo a regular bone density scan, but an individual’s arrival at a retirement community may prove a good first opportunity to provide educational materials on the lifestyle changes needed to support good bone health, along with an invitation to be formally screened using a tool such as the Fracture Risk Assessment Tool (FRAX).5 This would allow those people at risk of fractures to be identified proactively, rather than treated reactively. A retirement community would also be an ideal location for regular information sessions and group exercise activities.

In general, fostering healthier lifestyles in retirement communities may be crucial to reducing avoidable dependency on our overtaxed health systems. By promoting good diet and regular exercise, we can protect bone health and prevent debilitating fragility fractures and a host of other health complications associated with sedentary lifestyles and poor nutrition. Encouraging wellbeing and independence is key to healthy ageing. If we wait until people are frail and their quality of life has already diminished, we have waited too long.

 

Dr Clive Bowman is a member of the Osteoporosis and Fragility Fracture Policy Network’s Expert Advisory Group. He works as a Geratologist at City, University of London in the UK.

This blog post reflects the opinions of the author and does not represent the views of other Network members, nor those of Amgen. References are provided for the data and statistics cited in this blog post but all other information is given as the opinion of the author.
Date of preparation: March 2021    Hub-PRO-1220-00009
References +
  1. Hernlund E, Svedbom A, Ivergard M, et al. 2013. Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Archives of osteoporosis 8: 136
  2. Kanis JA, Cooper C, Rizzoli R, et al. 2019. European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporosis International 30(1): 3-44
  3. Thomas C. 2013. Models of special accommodation for older people across Europe. Brussels: ANEC
  4. Centre for Ageing Better. 2019. The State of Ageing in 2019. London: Centre for Ageing Better
  5. FRAX: Fracture Risk Assessment Tool. Welcome to FRAX. Available from: www.sheffield.ac.uk/FRAX [Accessed 19/11/20]