NIHR Global Health Professorship in Healthy Ageing in Sub-Saharan Africa

Life expectancy is rising more rapidly in Africa than any other continent. Whilst welcome, longevity alone is insufficient: maintenance of functional ability is crucial, i.e., Healthy Ageing.

Yet older people in Low and Middle-Income Countries(LMICs) are currently spending longer living with disability and dependence than in high-income settings, leading to individual, societal and healthcare burdens in the most resource-poor countries.

The World Health Organization(WHO) defines healthy ageing as 'the process of developing and maintaining the functional ability that enables wellbeing in older age'.

Functional ability consists of a person's intrinsic capacity within their environment, drawing on physical capacity to walk, see and hear, plus cognitive capacity.

Learning lessons from the demographic transition experienced in high-income settings, there is a time-limited opportunity to proactively plan innovative, integrated models of non-specialist delivered care for ageing populations in Sub-Saharan Africa.

This research is important to bridge the growing gap between need and resource and provide universal health coverage for older people.

I will build upon an established collaboration across three diverse African countries, The Gambia, South Africa and Zimbabwe, to understand drivers of healthy, and unhealthy ageing, and develop a scalable intervention to empower older people to maximise functional ability and enable wellbeing in older age.

I aim to develop and implement an evidence-based clinical framework for non-specialist assessment and management of chronic disorders of ageing which impact functional ability, to improve health and wellbeing of older people living in sub-Saharan Africa, through five workpackages(WP): WP1: I will characterise 'healthy ageing' using newly collected data from 5030 adults, age 40-90+ years across rural and urban Zimbabwe, The Gambia, South Africa, collected in the Fractures-E3 prevalence survey (funded by a £3.7m Wellcome Trust-NIHR partnership collaborative award which I lead).

I will (i) quantify healthy ageing, generating T-Scores for rural-urban/inter-country comparisons, (ii) understand associations between healthy ageing and key outcomes including quality of life, food insecurity and household wealth, (iii) determine drivers of 'unhealthy ageing', particularly multimorbidity clusters associated with adverse ageing profiles, and (iv) characterise metabolomic 'signatures' of healthy/unhealthy ageing.

WP2: Through formative work I will develop an integrated multi-component health check for community-dwelling older adults, screening for conditions impacting functional ability, spanning mobility, malnutrition, cognition, depression, vision, hearing.

If screening positive, initial on-the-spot care will be provided ±appropriate referral(s), using an integrated personalised care plan model.

The intervention will be informed by existing evidence, sensitive to local health policies and provision, local disease burdens, and older people's preferences.

In WP3, I will determine the feasibility, acceptability, effectiveness and cost-effectiveness of introducing community-based health checks in Zimbabwe, using a prospective hybrid intervention-effectiveness study design with a mixed-methods process evaluation.

Through community engagement and involvement in WP4, we will co-design and implement community-based healthy ageing peer-to-peer support groups, promoting functional ability by facilitating self-management.

WP5: Co-working with the WHO and stakeholders across sub-Saharan Africa, we will develop a 'Healthy Ageing Intervention Toolkit' guiding a structured, comprehensive, person-centred approach for non-specialist assessment and management of functional ability in older people suitable for scale-up across sub-Saharan Africa.