S2E4 Transcript: Designing For Better Health

Lori Pinkerton Rolet

Hello, and welcome to the Third Age design podcast, sharing essential information on senior environments. I’m Lori Pinkerton Rolet. And we have a very special guest today, Professor Sir Muir Gray, who says that ageing by itself does not cause major health problems until after the age of 90…potentially controversial, don’t you agree? Well, please keep an open mind as he’s an internationally renowned authority on health care, and has advised government in six different countries. We’ll be digging into designing for better health in today’s podcast. And keeping with TAD’s international approach, we have an extended innovation spotlight this month, as we speak to the CEO of a company conducting research in many countries, to provide an early diagnosis of dementia to prevent delays in treatment. And here’s where we all come in: to make interior changes easier and as soon as possible. It’s going to be a fascinating half hour. Voltaire is quoted as saying every man is guilty of the good things he did not do. Well, at a time of war, this seems particularly poignant. But we can also if we choose to take this into our personal and everyday contributions to society, we’ve got lots of choices, many of us, so we can do our day job, or we can do it continually better and better. And that’s why Third Age Design is here, to share information and learn from the experiences and important research of experts to improve environments for the Third Age, whether it’s in design for retirement village, care facilities, or updates to a private home. So now, in addition to the podcast, we have a website full of useful information. And if you hit join, you’ll automatically receive our at home safety checklists for an ageing population, as well as what we call a “TAD Extra” each quarter: exclusive information for our members. It’s really easy to sign up and entirely free so go to www.thirdage.design. Okay, let’s get started. Our guest today is Sir Muir Gray, Executive Director of the Oxford Centre for Triple Value Health Care, and a director of the Optimal Ageing Programme. He founded the National Library for Health in the UK and was the first person to hold the post of Chief Knowledge Officer of the National Health Care System in England. He’s advised several countries on health care systems, in fact, including Australia, New Zealand, Italy, Spain, and Germany, and he regularly delivers sessions on Health and Ageing at international events. He’s also a professor in the Nuffield department of surgery at the University of Oxford, and has written several books, including the wonderfully titled, Sod 70. He received the honour of Commander of the British Empire in the year 2000 And was knighted in 2005 for services to the National Health Service in the United Kingdom. Anyway, that’s only a small sampling of his biography, but you can find more on the website. One further comment: he has a spectacular accent. We’re delighted to have him on the podcast, you’re welcome to Third Age Design.

Sir Muir Gray

Thanks very much.

Lori Pinkerton Rolet

I had the opportunity to hear you speak the end of last year and I was really quite stunned that you made the comment that the ageing process does affect everybody from about the age of 40. But it does not in and of itself cause major problems until after the age of 90. You say that ageing is actually a loss of fitness.

Sir Muir Gray

I think we’ve got to be very careful about language. Oxford’s main businesses is language, of course, the Oxford English Dictionary. So the word ageing is used very loosely. And I believe we should be much tighter in the use of the word ageing as a normal, biological process, that’s quite different from living longer, that’s a separate process. But ageing by itself is not a cause of major problems until the late 90s. It certainly has an impact. It reduces your maximum level of ability maximum heart rate, for example, and reduces what we call resilience. Namely the ability to bounce back if you have a change of temperature or a trip or something like that. But if you were only affected by ageing, well, Her Majesty is a very good example. I mean, she’s been off light duties, but that’s because of COVID. So you need a bit of luck, of course, to avoid disease if you can’t prevent Parkinson’s ageing by itself without because the major problem.

Lori Pinkerton Rolet

But we have an expectation that it is in terms of just society’s expectations. Why do you think we have that so wrong?

Sir Muir Gray

Muddled thinking, muddled thinking. What we’re very clear from an analysis of the science are a few other processes taking place. One is loss of fitness. And that takes place from about the age of 22 on from the time you get your first job, wow, because there’s the modern environment. These are environmental problems, or lifestyle problems. It’s a car like computer, the desk job. So as lots of fitness centre diseases, and diseases get more common, the longer you live, not so much because of ageing, that because of the environment in which we live, the car, the computer, desk job and calories everywhere you can look. And then the third factor is negative thinking, the belief that it’s all due to ageing. So Lori I never want to use the word ageing again narrowly as the definition of the normal biological process.

Lori Pinkerton Rolet

We’ve got people who are moving into assisted living accommodation, sometimes they’re moving into care facilities, this sort of stereotype that we have, I’m imagining would affect people’s just response to those types of facilities and whether they even want to go there or need to go there. Do you agree?

Sir Muir Gray

Well, yes, I think, again, be very careful about language. I don’t like the word care. It implies doing things for, for people. So care homes, for example, and the word’s everywhere, and I’m not going to do away with the word much do I like to do so. And there’s a difference between caring about someone and caring for someone. And the word “assisted.” So we all need assisted living, you know, I need help from the telephone company. And I need help from the people who fill the petrol stations that are need help from a whole variety of people; no one’s independent. So we need to think about enabling people. And we just think about ways in which the environment can be changed, to enable people who remain active physically, cognitively and emotionally and to become more active. So it isn’t about a mental issue that we see.

Lori Pinkerton Rolet

Yes, and I know in your the Optimal Ageing programme, that you talk about those three things sort of physical, social and intellectual activity, and you say that it can even reduce the risk of dementia. Can you speak to that for a moment?

Sir Muir Gray

Yes, I’ve just published my latest books called Increase Your Brain Ability, and Reduce Your Risk of Dementia. And there are three ways to reduce your risk of dementia.

One is to keep your blood vessels open, same advice as for heart disease. The second is to protect the brain tissue by keeping well, being careful about trauma to the brain, watching drugs, including the drug the medical profession prescribed. But the third factor seems to be to continue to be involved. Isolation is a major problem. And we are involved in activities that challenges.

We all need challenge, at every age, you see, doctors who qualified before 2000 were told that brains couldn’t change. And all that happened after they get quickie was you lost brain cells. So that was completely wrong. And we now know that new connections, new circuits can form at any age, and even new nerve cells can form. So we can prevent, delay, slow down, and even reverse some of the changes that we see in dementia. There’s still Alzheimer’s disease, but that’s only one cause of dementia. So people now need to think differently, including the medical profession.

Lori Pinkerton Rolet

It’s interesting because you were saying just a moment ago, it’s about it’s about staying active, whether you’re doing things whether things are just being done for you. And in our podcast last month, Dr. Anne Fleming said that her research was showing that people who prepare their own food have a better nutritional intake than those who don’t. But when we’re designing facilities, architects and designers and people who develop these places, there’s always a catering consultant designing an industrial kitchen. Yes. And it’s only in dementia units where they have kitchens and then it’s mainly for like baking and doing activities not for producing food. With the average spend. So for example, in the UK, somewhere around three pounds a day per person to prepare food for people. And in the US, it’s as little as six to $7. It tends to be produced in bulk by chefs. So is there anything that we can do as designers to help facilitate people engaging in making and preparing their food and the the social engagement of doing that? Do you have any recommendations?

Sir Muir Gray

Oh, yes, I think we need to provide older people with less with less prepared food. And maybe maybe one meal a day, maybe not even here at places providing three meals a day, but here places they don’t like to give electric kettles in case the residents scald themselves. While it, maybe we should investigate the places where no one has ever scolded, because they’re always not being active enough to really compete change. And firstly, that people can prepare for themselves. Secondly, they can help one another, even more than probably all the people could be a good kitchen. It could be baking, to sell those cakes, to the local Wildlife Trust, which employs young people. So I’m all for all the people who’ve been baking, but I think they should do that to raise money for a good cause.

Lori Pinkerton Rolet

Right? Rather than just let’s fill your day with an activity. In other words…

Dr. Anne Fleming

….yeah, mission, a sense of mission, sense of purpose is very important.

Lori Pinkerton Rolet

And engagement, what you’re talking about is engagement in the wider community, ie outside of the four walls of the building in which they live.

Sir Muir Gray

Yeah, that’s the key. And I think also were looking at ways in which things they The gardens are over designed and over controlled, so we immediately reduce the garden contract, and give the responsibility for half the garden to the members as well as our residents, to the members of the community.

Lori Pinkerton Rolet

And the the word community is another one that’s very, very strong, isn’t it? Because one of the things that we hear and read about is older people suffering from loneliness, and sometimes depression, but what you’re talking about, puts them either out in a garden or potentially interrelating, with the rest of the community and with younger people as well, which would seem to address that a bit.

Sir Muir Gray

Yes, of course. But the big problem is probably people who are in their own house, an England semi-detached house. And I did a survey 45 years ago, and of the number of people living on the road, and that same exact shows, because it moves there for years before when it came to work in a car factory. So we think also by those people who are not in some form of group living, and for them, obviously, we should try and get them out more. But we also need to think of making sure that there, there are digital connections and communities, online communities that they can join in. But again, it’s good to have those are that a common interest, but also good if people have a sense of a sense of purpose or their belonging to a group? They’re trying to raise money for a good cause, digitally with other people and contributing to society.

Lori Pinkerton Rolet

Yes, absolutely. You’ve in been involved with the I’m not sure if it’s pronounced ESXi or exci. exercise prescription yet which actually prescribes workouts and gym sessions. So if we were designing community spaces, which will now call it what would you say is the equipment minimum which should be on hand for older people? If, if we’re looking at optimum health, are swimming pools required or weights required? What is the prescription? In general?

Sir Muir Gray

Yes, I don’t think much is required and we have the equipment, a weight she can shoot, it is very good for you so that you keep it in two kilogramme bags and you can pick it up every time a television. So there are ways we can find equipment. I think everyone should have resistance bands and stretching. It’s more motivation and support is more important. Hello, we are in virtual reality. There’s a little company in Oxford called the rover ROV R, which is a type of treadmill, which there’s no moving parts and very safe So I think there’s some high tech resources available. But the most important thing is, is not equipment, but knowledge, and giving people knowledge and support and encouragement to enable them to become more active.

Lori Pinkerton Rolet

So does that turn on its head a bit. Facilities may need, for example, physio therapists and that sort of thing. But it sounds as if there is perhaps some equipment already existing or coming online, which wouldn’t require staff to be present for safety purposes, for example, because a lot of these places are really understaffed. And it’s kind of going back to your comment about the kettle, people will err on the side of safety rather than erring on the side of health necessarily.

Sir Muir Gray

So I don’t like to watch sci fi that is no such thing as safe. It said there was a risk, and it’s no big clear. And there’s a major approach is publishing as the benefits outweigh risks. So there are surveys, occasional people fall down and break something. But we found more people fall down unless there’s activity. So we need to increase the activity, we change beliefs and attitudes, has encouraged people to become even more active.

Lori Pinkerton Rolet

It sounds like a more exciting environment in which to live as well.

Sir Muir Gray

I think we need less so right. But you should probably need as a certificate from induction you agree before you get in the lift. And I think it’s also very good to think of ways in which we can encourage people to be to use the environment which they are living, become even more active. And that’s why gardening is very good. Because it’s getting people out and giving them responsibility that shoulder their hand to show. So raise flower beds are practical, carefully manicured lawn.

Lori Pinkerton Rolet

Yes. And what about wild flower gardens? Yes. A more natural approach. Going back to what you were saying earlier about overly manicured spaces. It’s interesting, you’re talking about lifts. And in the US for those listeners, those are called elevators, elevators, but they are never front and centre in standard design, the lifts are in front and centre, but stairs tend to be hidden, or they’re even locked so that they can only be used by the staff or for emergencies. Again, from this sort of safety standpoint. Are we missing a trick here as well, in terms of just the design of the building itself? And what would be required on stairs to really make this work? Well?

Sir Muir Gray

Yes, I think that’s correct. I think you should, it could be a sitting area and every landing, there could be a copy of my book. So 70, chained to the roll, so be able to sit and recently went up. So I think it is a matter all the time of thinking about challenge. So I’ve been involved in design. So I’m about to approve of the idea of putting plugs at waist height and that sort of thing. So there are some things worth doing like that. But in general, the the issue is thinking about ways in which the members of the community could become even more active.

Lori Pinkerton Rolet

And are there any other design interventions which you can think of which also might assist in optimal ageing besides stairs? Or is it just the more general concept of use it or lose it?

Sir Muir Gray

Well, I do feel we need a lot more housing for people in their 60s, 70s, 80s and 90s. And I just think it’s good just to classify by chronological age like that, and not call it supported housing or whatever, because that will free up a lot of dwellings, attractive dwellings, that would free up a lot of other occupied properties for families. So I think in the UK, in particular will be very slow in developing resources for people in their 60s, 70s, 80s, 90s. But hopefully now, with with shops going bust in the High Street, we could start to see dramatic growth in accommodation for people in their 60s, 70s, 80s and 90s. In city centres tend to be a bit on the outskirts. That’s fine if you want to go and live in the suburbs. I certainly think there’s going to be an opportunity now for converting department stores. And I could think of many very attractive places to live in the middle of a city near concert halls cinema library with a bit of bustling our roundabout.

Lori Pinkerton Rolet

I’ve got one final question for you. Why did you pick up this particular mantle with with all of the experience that you’ve had in so many different areas? Why did you personally decide that this was a fight worth fighting in terms of changing some of our perceptions?

Sir Muir Gray

Well, a bit back 50 years to my first job in public health. But I said to my boss at the time, what would you like me to do? They said, What do you think needs to be done? And I said, we’re always people looking at healthy children. But no one knows that many people are over 60. And he said, Well, why don’t you go. So I’ve been reading about the challenges facing people in their 60s 70s 80s and 90s. And if you go back 50 years, I could see the population changing. So one of my motto, my printer was to be reactionary. So operation on gravity was where the action was. And I that I saw a lot of muddled thinking. So I decided, that’s one of the jobs I’ve got to keep going at. So I’m still going at it and sold it, and what solid bought them still fighting the battle to help people live longer, better, now becoming even more active, physically, socially, emotionally.

Lori Pinkerton Rolet

Thank you so much for sharing these thoughts and challenging our thinking, really appreciate you being on the podcast.

Sir Muir Gray

Thank you very much. Designers can do a great deal.

Lori Pinkerton Rolet

You know, it’s important that as a sector, we provide some joined up thinking, and sometimes it feels as if doctors are doing one thing, support services and occupational therapists, something else. And all of that is of course necessary, but it’s probably helpful to see where there may be overlaps, and to discuss what those might be. This month, we have an extended Innovation Spotlight feature, and I’m speaking with Dr. Bushra Siddiqi, CEO of CogniDX, health information and analytical data analyst. Bushra, welcome.

Dr Bushra Siddiqi

Hi, Lori, and thank you for giving me the opportunity and platform to talk about our very important mission.

Lori Pinkerton Rolet

Yes, it does sound very important. We had spoken once before on the on the phone. And I’m wondering if you can give the listeners a snapshot of the research that you’re conducting, and why you think it’s needed?

Dr Bushra Siddiqi

Yes, of course, Lori. Let me start off by giving a brief snapshot about dementia, which is a syndrome that has no cure and no survivors. And it’s growing rapidly every three seconds globally. So as you know, it’s a pandemic. That’s one of the biggest global health challenge of the 21st century. And currently, from the 55 million people in the world living with dementia, it’s astounding to know that 41 million of them never get a diagnosis. And that is because early stage dementia is extremely difficult to diagnose, especially in a primary care setting. And waiting times to get a diagnosis can range from a few months to a few years due to the deceptive nature of the symptoms of dementia, and how they can be confused with other conditions. So as the benefits of an early diagnosis of dementia are profound, not only for patients, but also of course for the carers and healthcare systems. Here at CogniDX, we have developed an electronic tool that provides early stage diagnostic and long term care solutions for dementia. So if you’ll allow me to quickly give you an insight into our primary innovation, so we have coaching called edX with a very hybrid approach. First, we uniquely digitise and accelerate the complete comprehensive and fundamental procedure of history taking. And alongside that we also provide a thorough cognitive assessment to further identify the cognition decline our machine learning algorithms and instantly reduces the probable dementia diagnosis down to the exact subtype in the comfort of the patient’s home and sends the diagnosis instantly to the GP to take an appropriate action.

Lori Pinkerton Rolet

This is still going through the doctors then, so it’s not that you’re remotely diagnosing patients in any way and telling them what the diagnosis is.

Dr Bushra Siddiqi

And hence CogniDX ethically will not provide the diagnosis on screen to the patient, and instead a detailed report which will be delivered immediately to the GP long along with a complete plan of action that includes other physical and laboratory investigations to conduct to strengthen the diagnosis before they’re furnished to the specialists.

Lori Pinkerton Rolet

So what sort of countries are involved in the research that you’re currently doing?

Dr Bushra Siddiqi

So currently, we have done two pilots on retrospective patients in Saudi Arabia, and we have a 97% accuracy rate. So because we need the product to be validated in several different demographics, before we launch it, we are now embarking on a third trial on prospective patients in Oregon, USA. And in the pipeline, we have Vancouver, Canada and Singapore for trial, as well.

Lori Pinkerton Rolet

Right. And then I understand you’re going to be setting up a follow up sort of support service. And I think this may be where interior environments might play a part. What do you think that support service will end up looking like? And how can the architectural and design community participate?

Dr Bushra Siddiqi

Yeah, so at CogniDX, Lori, we’re offering a holistic approach to patients with cognitive complaints. So alongside our primary diagnostic service, we will also be offering two more services. The first one is Cogni Health, and that’s for people diagnosed with MCI mild cognitive impairment with a pre dementia phase, and how they can adjust their lifestyle to significantly delayed the risk of developing dementia, specifically Alzheimer’s. And then we have Cogni maintenance, which is a follow up in maintenance of quality of life service for dementia patients in every phase of their in their parents. And not this is a service which is extremely crucial as once the patient is diagnosed with dementia, and they start their journey the dementia pathway. CogniDX will take care of providing the patient with information and guidance on what symptoms to expect and how to deal with them. How enriches the community support resources at their fingertips to improve quality of life for not only them, but also their carers who burn out faster. And finally, how to consider adapting the design of environments they live in, it contributes positively to their well being and reduces anxiety and confusion and the ability to read. So obviously, we know that making sense of our environment is so crucial and paramount to health and quality of life. And a well-considered interior design can help reduce the patient’s anxiety by providing tools to help people make sense of their surroundings. And research also shows that good design of the physical environment where patients will be spending most of their time in is increasingly recognised as an important aid and a treatment in caring for people with dementia and allowing them to live more independently.

Lori Pinkerton Rolet

Right. So you’re taking quite a holistic, broad approach. And it sounds like you’re starting with getting the early diagnosis to allow things to be put in place, whether it’s environmental, the sorts of support that people need, the sorts of support that carers require. And then actually supporting people through that journey in their life. If people wanted more information as to how they or their doctors are there in what way they can become engaged, where’s the best place for them to go?

Dr Bushra Siddiqi

So as you know, Lori, we’re still in our clinical trial stage. But I would encourage your listeners to watch out the space for our coming home based diagnostic tool that was referred by GP. But until then, we can keep up to date with our progress to our website at www.CogniDX.co.uk. Or if you’re interested in partnering with us for trials or chatting with me or my co-founder, then you can contact me directly on my email, which is bushra@cognidx.co.uk.

Lori Pinkerton Rolet

It’s really exciting new areas that you’re looking into and wishing you the best of luck with all of those things.

Dr Bushra Siddiqi

So thank you so much Lori, for this amazing opportunity to showcase our work and the impact we want to have on the early diagnosis and quality of life for people suffering with dementia. Thanks a lot.

Lori Pinkerton Rolet

Exciting developments to look forward to there. Just a quick look then at our TAD international events calendar. The Retirement Industry Conference will take place at Boston’s Park Plaza Hotel in Boston, Massachusetts, USA, from the 11th to the 13th of May. The fifth annual Future of Age Care summit 2022 will be held at the Sofitel Sydney, Australia from the 15th to the 17th of June. And there’s another large event taking place on Australia’s Gold Coast. From June the 20th to the 22nd, which is the National Retirement Living Summit. You’ll find more international shows and conferences. They’re not all in Australia, you know, on the events page at Third Age Dot Design, and let us know via the contact page if you have an event you’d like to see listed there. Thank you to today’s special guest, Professor Sir Muir Gray, to Dr Bushra Siddiqi, to TAD’s producer Mike Scales, to Valerie Adler of The Right Website, to Peter Thorne, who composed our theme music and is playing the piano with Mary Blanchard on flute. And finally to you. Thank you for being part of a community who believes we can improve senior environments together. I’m Lori Pinkerton Rollet and I hope you’ll join me for the next one.