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Agetech World podcast: The age-old lessons we can learn from Japan

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With governments across the globe facing a ticking timebomb when it comes to funding the care needs of their ageing populations, a leading social and medical anthropologist has told the latest Agetech World podcast that there is much Japan can teach policymakers.

Click here to listen to the latest Agetech World podcast

Among Dr Iza Kavedžija’s main research interests is exploring the lived experience of ageing in urban Japan.

The Assistant Professor of Medical Anthropology in Cambridge University’s Department of Social Anthropology has lived in Japan and conducted extensive ethnographic fieldwork with two distinct groups of people in the Kansai region.

This led to her first in-depth study, Making Meaningful Lives: Tales from an Ageing Japan, and has underpinned a series of journal articles addressing a broad range of topics including care, hope and hopelessness, and happiness and gratitude.

In conversation with Agetech World, Dr Kavedžija said Japan had long been known for its widespread respect for the older population and its sense of obligation to caring for them.

The country has one of the world’s oldest populations, with nearly 30% of its 125m inhabitants aged over 65. This age group is expected to account for 34.8% of the populace by 2040.

Whilst this is inevitably putting a strain on Japan’s long-term care system, the country’s politicians and wider society are continuing to learn, evolve, and devise radical solutions to meeting this growing demographic challenge.

Japan has always had a strong tradition of family caring for its older citizens. But to this has been added a Long-Term Care Insurance (LCT) scheme, a complete package for the over-65s covering both the financing and the implementation of social care according to needs, supported by mandatory premiums levied on those aged 40-plus and co-payments from users.

Further responding to the nation’s ageing society, Japan is preparing to introduce a new Community-based Integrated Care System by 2025, with the aim of ensuring the comprehensive provision of health and nursing care, housing, and livelihood support.

Japan has also been working on developing robots to automate care for older adults, and other innovations include government investment in non-medical activities that can help prevent age-related illnesses; helping the over-65s flourish by working with them in their homes and communities rather than expecting them to conform to current societal norms or live in neglect; and making their towns and cities easier to navigate so seniors can still participate in everyday life whether for pleasure or work.

The number of residential homes is restricted with the emphasis on community care

Dr Iza Kavedžija

Asked what Japan can teach the likes of the UK – which is facing a soaring health and care crisis – Dr Kavedžijan said: “I think there are many things that Japan has paid close attention to.

“I think the Long-Term Care Insurance is one of a kind… that allows for the drawing on services from various sectors, so it is possible to create a mix of forms of support, whether it be home care, whether it be various forms of assisted living…so a lot of interventions that are in the community and a lot of providers that range from non-governmental to the state sector to the private sector, where one can create a plan of care and support with a care manager that’s tailored to the needs (of the individual) drawing from the broad range of services.

“It isn’t always the same sort of story where the plan has led towards institutional living.

“In this sense I think Japan has been particularly successful. Of course, as the proportion of older people is so high in the population, this system is somewhat coming under strain. I don’t want to represent it as a particularly rosy situation. It isn’t. There are challenges to it.

“But I think nonetheless that this very, very well thought out system of support is important and it also cultivates these various forms of dependence, or interdependence, where one can draw on different types of assistance.”

Dr Kavedžija added: “It actually also allows people to continue living relatively independent lives….it doesn’t necessarily mean they have to move in with their children.

“So, they think of older people as the ones who continue the tradition and social changes as something that is brought on by younger people.

“In this case, I think we have seen very clearly that it is older people themselves that have often been the active leaders in social change. They have been the ones often saying, ‘I know there is an expectation for me to depend on my older son, but I don’t want to be a burden on my children.’

“So, they cultivate various forms of care in the community and they themselves become very involved in a huge range of activities, volunteer activities, that foster support in the community and create these communities of care.

“That is, I think another lesson that would translate well elsewhere.”

But Dr Kavedžijan also gave a note of caution. “I don’t want to paint too much of a positive picture because certainly challenges are there. That is something that again is perhaps an important lesson, and that is to do with the circulation of care, as I like to call it, where we need to think of care in systemic ways.

“For instance, elder care largely depends on a volunteer workforce, and that had for many years often consisted of women.

“In order to support better care for elders I think it is necessary to consider in which ways we can perhaps support childcare. So, to think about these flows of care in a much broader way and try and foster support across the board rather than thinking of them as separate units…that are not intertwined.”

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Europe: Improving access to early-stage lung cancer care

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Europe: Improving access to early-stage lung cancer care

Researchers from Amsterdam UMC Cancer Center Amsterdam have looked at inequalities in access to early-stage lung cancer care in Europe.

Early-stage lung cancer has stark differences between European countries regarding access and reimbursement.

There are also differences in reimbursement times and indications between the European Medicines Agency (EMA) and the US Food and Drug Administration (FDA).

Researchers from Amsterdam UMC Cancer Center Amsterdam analysed the landscape, publishing their results in The Lancet Regional Health Europe as part of a series on the latest developments in the treatment of this lung cancer.

“Tackling inequalities in access to care must be a common European priority,” says Amsterdam UMC pulmonologist Idris Bahce. In collaboration with colleagues from seven European countries, Bahce used a literature review to map out the latest developments and analyse access to these new treatments from a European perspective.

“The existing differences in healthcare systems and reimbursement structures between European countries threaten to exacerbate healthcare inequalities at both European and national level. We therefore call for a collective European approach to reduce these inequalities,” says Bahce.

He suggests measures such as more international cooperation between the EMA and other registration authorities, harmonising cost-effectiveness procedures in European countries, a more critical evaluation of reimbursement criteria and improving multidisciplinary collaborations around the patient.

The standard treatment for fit patients with early-stage lung cancer has always been surgery, sometimes combined with pre- or post-operative chemotherapy. Recently, the EMA has approved new treatments such as immunotherapy, which appear to significantly improve survival rates after surgery. More approvals of innovative treatments are expected, potentially further exacerbating existing inequalities within Europe.

In addition to the Dutch hospitals Amsterdam UMC and Erasmus MC, colleagues from Spain, France, Germany, England, Italy and Poland also contributed to this international study as well as a Review and a Viewpoint in The Lancet Regional Health Europe.

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Study looks at link between adversity and cognitive decline

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A new paper has examined the relationship between childhood adversity and psychiatric decline, as well as adult adversity and psychiatric and cognitive decline. 

The findings revealed just one instance of adversity in childhood can increase cases of mental illness later in life. It also revealed that adverse events in adults can lead to a greater chance of both mental illness and cognitive decline later in life. 

The paper has been published by Saint Louis University associate professor of health management and policy in the College for Public Health and Social Justice, SangNam Ahn, Ph.D., in Journal of Clinical Psychology.

Ahn stated: “Life is very complicated, very dynamic. I really wanted to highlight the importance of looking into the lasting health effect of adversity, not only childhood but also adulthood adversity on health outcomes, especially physical health and psychiatric and cognitive health. 

“There have been other studies before, but this is one of the first that looks into these issues comprehensively.” 

Ahn, along with his team of researchers, examined data from nearly 3500 individuals over the course of 24 years. The group took the longitudinal data and evaluated it using a list of lifetime potential traumatic events.

The research team included childhood adversity events such as moving due to financial difficulties, family requiring financial help, a parent experiencing unemployment, trouble with law enforcement before the age of 18, repeating school, physical abuse and parental abuse of drugs or alcohol. 

Adulthood adversity events included the death of a child, the death of a spouse, experiencing a natural disaster after age 17, firing a weapon in combat, a partner abusing drugs or alcohol, being a victim of a physical attack after age 17, a spouse or child battling a serious illness, receiving Medicaid or food stamps and experiencing unemployment. 

The study determined that nearly 40% of all individuals experienced a form of childhood adversity, while that number climbed to nearly 80% for adulthood adversity. Those who experienced childhood adversity were also 17% more likely to experience adulthood adversity. Only 13% of individuals sampled reported two or more forms of childhood adversity, while 52% of adults experienced two or more forms of adult adversity. 

In cases of either childhood adversity or adulthood adversity, researchers found individuals who experienced adversity were also more likely to experience anxiety and depression later in life, and in the case of adulthood adversity, were also more likely to experience cognitive decline later in life. 

Individuals with one childhood adversity experience saw a 5% higher chance of suffering from anxiety, and those with two or more childhood adversity experiences had 26% and 10% higher chances of depression and anxiety, respectively. Individuals who experienced two adulthood adversities had a 24% higher chance of depression, while also experiencing a 3% cognitive decline later in life. 

While most of the results were expected or unsurprising, one area that stood out to Ahn was education. Those individuals studied who reported higher levels of education saw a reduction in the number of adversity experiences. Ahn hopes to study this avenue more to learn how education may be able to mitigate or prevent these declines. 

“Before including education, there was a significant association between childhood adversity and cognitive impairment,” Ahn said. 

“But when including education as a covariate, that significant association disappeared. Interesting. So there were important implications here. Education and attending school, people could be better off even if they were exposed to childhood adversity. They’re likely to learn positive coping mechanisms, which may help avoid  relying on unhealthy coping mechanisms, such as smoking or excessive drinking or drug use.

“Education is quite important in terms of health outcomes. If I am educated, I’m likely to get a better job, have a higher income, and live in areas with less crime. I’m likely to buy gym membership or regularly exercise. I’m likely to shop at Whole Foods and get proper nutrition. All of which help combat these adversities we hinted at in the study. So the education and health outcomes are already closely related, and that is what we saw in our study.”

Ahn also encourages clinicians and everyday people alike to discuss their stress. Clinicians can learn more about their patients and have a better approach when it comes to their physical and mental health, while others could potentially relate to shared experiences. But through awareness and recognition, these adverse experiences could potentially have less serious, lasting effects. 

“Public health is very interested in stress,” Ahn said. “But we’re still examining how daily stress impacts our long term health outcomes. So to see the effects here in the study, I want people to pay attention to their stress and proactively address it. Clinicians should have deep discussions with their patients about their stress and mental state. And those topics can be approached in other areas too, like the classroom or the dining room table. The more we are aware of stress and discuss our stress, the better we can handle any adversities we find in life.”

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New tool to explore mechanisms of age-related diseases

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New tool to explore mechanisms of age-related diseases

A new screening tool has been developed that will investigate the mechanisms behind conditions such as cancer, arthritis, neurodegeneration and cardiovascular disease.

Wellcome Sanger Institute researchers and their collaborators at Open Targets and EMBL’s European Bioinformatics Institute (EMBL-EBI) have developed the screening tool called scSNV-seq.

The tool has been designed to uncover how genetic changes affect gene activity that can lead to diseases such as cancer, autoimmunity, cardiovascular disease and neurodegenerative diseases such as Alzheimer’s and Parkinson’s. 

The tool enables the investigation of thousands of DNA mutations identified by genetic studies in one experiment, and will help to guide the development of advanced diagnostics and treatments.

scSNV-seq allows the rapid assessment of the impact of thousands of genetic changes in cells that have never been screened before, directly connecting these changes to how those same cells operate. 

This technique helps researchers to pinpoint mutations that contribute to disease, which will offer crucial insights for developing targeted therapies.

In a new study, published in Genome Biology, the team applied scSNV-seq to the blood cancer gene, JAK1, accurately assessing the impact of JAK1 mutations.

The assessment revealed for the first time that certain mutations caused a “halfway house” phenotype cycling between different states which was not possible under previous approaches.

The technique is designed to demonstrate versatility across cell types, including hard-to-culture primary cells like T cells and stem-cell derived neurons, as well as various editing methods such as base editing and prime editing. 

Applied on a large scale, scSNV-seq could transform understanding of the genetic changes driving cancer and decoding genetic risk for Alzheimer’s, arthritis, diabetes and other complex diseases.

Dr Sarah Cooper, first author of the study at the Wellcome Sanger Institute, stated: “In an era where the rate of genetic variant discovery outpaces our ability to interpret their effects, scSNV-seq fills a major gap for studying challenging cells like T cells and neurons. 

“We are already using it to shed light on the impact of Alzheimer’s and Parkinson’s risk variants on brain cells.”

Dr Andrew Bassett, senior author of the study at the Wellcome Sanger Institute, said: “Our technique is able to directly connect effects of mutations to how a cell behaves, revealing downstream impacts that previous technologies alone cannot deliver. 

“The technique speeds up the identification of causal genetic mutations, which will allow better diagnosis and deepens our molecular understanding of diseases, paving the way for more targeted and effective treatments.”

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