All posts by Dianne Campbell

About Dianne Campbell

Dr Dianne Campbell is a British General Practitioner based in Scotland. Specialising in Out of Hours Emergency Care. Undergraduate degrees: MBChB Glasgow 2003 BScMedSci(Hons) Developmental Medicine Glasgow 2001 Doctor Campbell carried out hospital jobs in Acute Medicine, Surgery, Care of the elderly, Accident & Emergency and Cancer Care before completing training in General Practice and has been a Member of the Royal College of General Practitioners since 2009.

Antonio Capurso, Gaetano Crepaldi and Cristiano Capurso, Benefits of the Mediterranean Diet in the Elderly Patient (Cham: Springer, 2018)

Book review (editorial review), , , ,

Although ageing is a natural process, it has been heavily politicised in recent years. The growing ageing population has impacted healthcare costs and economic planning worldwide. Where consideration of whole populations is essential, however, this approach is not necessarily helpful to individuals who are concerned for their own ageing and for that of their loved ones and patients.

We all want to know what best to feed ourselves for optimal health. As a British GP, I not infrequently have to advise people to stop taking their medical advice from Facebook. In an age where, increasingly, nutritional trends are being taken from the latest social media influencers, nutritional science is more important than ever.

This is where wonderful texts like Benefits of the Mediterranean Diet in the Elderly Patient come in. Spoiler alert – The Mediterranean Diet is really good for us. I’m sure the authors Capurso, Crepaldi and Capurso will not mind the spoiler, given they’ve indicated the slant of their conclusions in the title of the book.

This book illustrates the role of the Mediterranean Diet in connection with wellbeing in nutrition. They approach the subject of ageing with the aim of preventing frailty – where ill health, social limitations and loss of confidence combine to reduce quality of life. The authors set high standards for living into old age too. Citing potential for new careers, education, opportunities and directions as being achievable for those who can retain their health into old age.

The book is broken down into sections for each foodstuff element in the diet: extra-virgin olive oil, cereals, fruit, vegetables, nuts, legumes, pulses, fish, herbs and red wine, outlining the relevant seminal and more recent relevant research for each.

It begins with extra virgin olive oil – the jewel in the Mediterranean crown – its composition and effect on cardiovascular disease, diabetes, neurodegenerative diseases and cancer.

Where extra-virgin olive oil has been relatively uncontroversial in its perceived nutritional benefits in recent years, cereals have had less of a stellar reputation. Some of the Western world seems to have all but abandoned cereals completely in recent years, which, given the antioxidant and fiber effects, seems somewhat reactionary. This chapter made for the most interesting reading for me, as a result.

In stark contrast to the popular cultural view of carbohydrates as a path to obesity and type II diabetes, Capurso et al meta-analysed the studies associated with high-quality grain-based foods to demonstrate the nutritional benefit that can be harnessed. In particular, they point out that, traditionally, Southern Mediterranean population diets contained sourdough leavened bread rather than white or whole-wheat bread. It is sourdough bread in particular which has a lower glycaemic index and gives a less pronounced glucose response in the blood relative to other, more processed forms of bread. The authors did not disagree with the notion that low-quality, high-volume carbohydrates lead to an increase in cardiovascular diseases, type II diabetes and obesity. However, rather than conclude that carbohydrates should be excluded from the diet, as in the currently fashionable low-carb high-protein diets, they instead advocate for reasonable portions of high-quality sourdough breads, which give the benefits of fibre and oligosaccharides, reducing inflammation and giving protection against chronic metabolic disease.

Alcohol, similarly, is a controversial topic worldwide when it comes to healthcare. This topic too was dealt with in a sensible and practical manner. The authors acknowledge that when it comes to assessing the relative benefits of drinking alcohol, any study is difficult because of the difficulties in gaining a true picture of consumption. Still, people do not necessarily tend to drink wine exclusively, wine being the traditional alcoholic drink of the Mediterranean Diet. Their meta-analysis showed that a moderate consumption of alcohol, particularly red wine, is beneficial to health and in particular protective against cardiovascular disease (CVD). Though this effect appears to be particularly prominent in the consumption of red wine and shows most benefit to high-risk middle-aged men and women, the benefits seem to extend beyond these groups and are not limited to red wine. In addition, red wine has been linked to the prevention of numerous degenerative diseases and cancer.

Although this is an academic text at its core, I very much enjoyed the inclusion of cultural context. Each chapter included the cultural context of each element of the Mediterranean Diet and how it was incorporated into everyday life. For example, in the context of alcohol, the authors address ancient Rome, where wine was diluted with water in a ratio of 1:3. As a British and Scottish GP, I always have to treat studies on the benefits of alcohol with caution. Where I trust the science, as with all science, it must be applied correctly. The authors correctly state that all of the evidence for the benefits of alcohol in the improvement outcomes in primary prevention of cardiovascular disease occur in the context of moderate drinking. All too often, these studies are converted into press articles which are used as an excuse to drink far more than is healthy.

This brings me back to my original point. Quality of information matters when it comes to nutritional advice. How we feed our vulnerable matters – both our young and our elderly. This book represents a solid reference text for anyone looking to educate themselves on the scientific basis for recommending the Mediterranean Diet and I’ll be keeping it on my bookshelf. I can’t promise it will prevent the rise of the next online influencer-based fad, but fads come and go. Where a social media influencer fad will fade into obscurity, science will endure well into retirement age, remaining fit enough to take on new adventures with a warm plate of pasta al pesto and a good glass of red wine.

Zbigniew Wozniak, The Elderly in Social Policy. Towards a New Architecture of Gerontological Programmes (Development in Humanities, Volume 4, Lit Verlag, 2013)

Book review (editorial review), , , ,

 

 

As a British General Practitioner, it was with great interest I read this book. While the concepts under discussion are familiar to me, approaching these from a humanities point of view brought a fresh and positive perspective.

 

Wozniak begins by detailing the various factors under consideration when developing social policy for older adults. A global shift towards an older population and lower birth rate is well documented and is well summarised here. The escalating economic difficulty in funding social policy, as it currently stands, informs the urgency with which the author approaches the subject.

 

  He goes on to detail normal biological changes associated with human ageing in general, while at the same time, emphasizing the wide variation in functionality between individuals of the same chronological age.  He correctly identifies that there can be a tendency to over-medicalise what is, in fact, a normal ageing process. He emphasises the importance of mental health, social interaction and proposes that identifying “isolators”- factors isolating individuals from their community – should form part of the assessment of an individual’s care needs. The author asserts that in doing so, we can empower an individual to access resources of all types around them. Developing this empowerment, contributing to maintaining an individual’s independence, is a key-factor in Wozniak’s new model.

 

In Chapter II of the three-chapter book, the author outlines some predictions of scenarios of the possible social consequences of population ageing. For example, considering technology, computers could be a positive connection to the outside world, contributing to a sense of community even for the housebound. For those without access to technology, however, an obvious opportunity gap arises. Also, a move toward a society of more inter-generational solidarity is postulated, widening the age ranges involved in the workforce, education and family life. Mentoring and resource exchange between generations could lead to a “society for all ages”, increasing the wellbeing of all.

 

These first two chapters form the basis for the author’s three-layer framework: A holistic view of social policy concerning the elderly, outlined in Chapter III.

The author correctly suggests that the current model of care is based on that of “solving problems” as they arise. Interventionist and emergency-based, we are simply lurching from event to adverse event, attempting to serve each individual, allocating increasingly squeezed resources only when a crisis occurs. Thus, he suggests that a move away from an emergency/interventionist model of care, towards greater expenditures on prevention, increasing awareness and sensitivity to the problems and needs of the ageing population.

 

Included in the book are detailed frameworks of the sectors involved and how each (for example, the labour market, housing, health, family and culture) might be inter-generationally structured to promote primary, secondary and tertiary prevention. He argues that the complexity of existing individuals points to the need for a complex and flexible set of structures on which to base care of the elderly promoting a society based on empowerment of both the elderly and younger generations, whilst allowing each to support the other. The principles are a move away from measuring policy by a single paramount outcome, such as “added years of life” for example, towards a broader process of developing a more robust intergenerational solidarity.

 

For example, employment and workplace policy must exist to adequately support family care of the elderly, in the same way that maternity and paternity employment rights have been developed to support employment and the care of young children. Similarly, policy which supports older adults’ contribution to childcare, mentoring and education contributes to the intergenerational exchange Wozniak is seeking to support.

 

Wozniak’s arguments confirm my fears that there are no easy answers to the “problem” of an ageing global population, though it is refreshing to read such positive writing on the subject. Though the aims here are lofty, he argues well, calling for a rise above the traditional solution of simply increasing funding to the current structures.  The models described reprsent a well-grounded basis for a change in approach to the organization of the Welfare State.

 

The structure of the prose can be complex at times, for those, like me, outside the field of philosophy, but it may help readers to begin at the summary chapter. This gives a helpful overview, not detailed enough to negate the benefit of the main chapters, but making them easier to digest.

 

I would recommend this book to undergraduate medical students as a companion to medical sociology studies. For postgraduate medical and GP trainees, I would suggest that the positive discussion of care of the elderly is not like anything I have read elsewhere, perhaps because of its non-medical approach. Regardless, I hope this work serves to inform European policymakers of an alternative approach to the formation of future social policy.