Promoting Healthy and Active Aging: A Multidisciplinary Approach, published by Routledge, consists of 14 chapters by 24 contributors based in Portugal. The book centres on the efficacy of a multi-disciplinary intervention strategy to promote active/healthy ageing using technological resources. The underpinning model is an applied intervention model, AGA@4life, based on the comprehensive geriatric approach (AGA; avaliação geriátrica ampla in Portuguese). Proposed in the 1930s by Marjory Warren, AGA is situated on the diagnostic–intervention continuum by recognising physical, mental and social limitations, and disabilities of older adults to maximise ageing. The major dimensions of AGA are: mental health/cognition, environment and social context, functional state, health, nutrition and therapeutics.
Although the significance of adding ‘@4life’ is unexplained, the model was developed through a research project to meet the societal challenge of demographic ageing. In Chapter 1 (pp. 1–8), Pereira explains that demographic ageing presents four key challenges to society: public administration, care-givers, academia and individual dignity. Therefore, a multi-disciplinary approach to geriatric care is essential. Importantly, AGA@4life requires clinical characterisation and diagnostic evaluation of: functional capacity, fall risk, comorbidity, cognition, pharmacology, nutrition, hearing/vision and environment. The strategic action reflects AGA's overall philosophy of ‘valuing the older adult, promoting health and wellbeing, independence and autonomy, mobility, and contributing to the community’ (p. 4). This model appears to be unique to Portugal, with all published work employing AGA@4life written by contributors of this book (a Google Scholar search using ‘AGA@4life’ (any time) returned 72 results).
This book aims to demonstrate the efficacy of a multi-disciplinary intervention strategy for promoting active and healthy ageing, with the assistance of dedicated technological resources. The multi-disciplinary model translates into chapters on health, nutrition and therapeutics (seven chapters), functional state (three chapters), mental health and cognition (two chapters), and environment and social context (one chapter). There are 11 literature reviews/summaries and three empirical research studies. With regards to structuring, it may have been advantageous to use the figure provided (p. 3) to organise the chapters. Therefore, they do not flow naturally and jump between dimensions, reading as a loosely organised report of research relating to the AGA@4life model. Finally, there is an imbalance between dimensions, with more chapters focused on health versus the social context.
In Chapters 2 (pp. 9–23) and 3 (pp. 24–35), the importance of exercise-based intervention programmes is discussed for preventing falls, and the challenges for a successful intervention. Both suggest that exercise prescribed by qualified professionals can benefit older adults. Chapter 4 (pp. 36–55) presents research exploring an online platform, BrainAnswer, to address imbalances between needing care and a lack of medical professionals. Chapter 5 (pp. 56–64) provides an overview for undertaking a clinical assessment of nutritional status, with causes of malnutrition in older adults listed. Chapter 6 (pp. 65–82) offers research findings evaluating indoor and outdoor air quality in a day-care centre (in Portugal), and prevalence of symptoms and pathologies of older adults.
Chapter 7 (pp. 83–89) discusses older adults self-medicating without advice from health-care professionals/knowledge of the consequences associated with polymedication. Chapter 8 (pp. 90–98) explores the importance of the auditory system to develop and maintain oral communication. A short summary of a study which evaluated the effect of auditory training on older adults’ speech is included. Chapter 9 (pp. 99–113) discusses cholesterol and the impact ageing has on it; concluding that prescribed exercise, diet and prescription medication can improve quality of life. Chapter 10 (pp. 114–123) is an overview of the key dimensions and effects of ageing, diagnostic procedures, active ageing and the benefits of physical activity.
Chapter 11 (pp. 124–129) discusses the impact ageing has on the heart and cardiovascular system. The AGA@4life model is evaluated regarding cardiac structure, function and health. The authors conclude that the model produced significant effects on functional parameters, which may improve older adults’ functional ability and quality of life. Chapter 12 (pp. 130–140) is a detailed review on the concepts of arterial ageing, early vascular ageing and determinants, arterial function and interventions to improve this through targeting lifestyle habits. Recommendations for non-pharmacological strategies (e.g. smoking cessation, reduced alcohol consumption, physical activity and nutritional changes), cognitive stimulation programmes and pharmacological compliance are reported.
Chapter 13 (pp. 141–148) examines habitual changes and the impact this has for an ageing population, with a focus on the liver during the ageing process. The link to the use of the AGA@4life model is unconvincing, as the ‘same intervention programme also addressed food issues that may also contribute to the improvement of liver characterization’ (p. 146). The final chapter (pp. 149–160) considers neurocognitive changes occurring with ageing and strategies to promote better cognitive function. The main conclusion is that a key element of personalised interventions should be the promotion and preservation of cognition.
This book is designed as an overview of the efficacy of the AGA@4life model through research, using a biomedical perspective on ageing. This is a common thread and, arguably, is contradictory given the emphasis on holistic approaches to wellbeing. Consequently, qualitative evaluations are unacknowledged but may have provided an interesting and in-depth dimension for understanding key social issues (e.g. poor wellbeing, barriers to exercise and health-care services, limited mobility, loneliness).
This book provides an insight into areas which may not be initially considered when discussing healthy and active ageing. Additionally, each chapter provides a key points list for an easy summary (however some are repeated throughout). Each chapter does not note limitations of the research within that field, making it difficult to determine gaps in the knowledge. Finally, it would have been beneficial to include a conclusion chapter on the model itself or a case study discussing implementation and success in achieving improved wellbeing, health and activity levels. The challenges associated with the model are fleetingly considered (p. 138) and include translating it into a nationwide programme in primary care units with older adults in their daily life.
This book will be of interest to researchers/applied professionals working in ageing and health, gerontology and wellbeing. It will also be of interest to doctoral researchers and scholars looking to broaden their knowledge into clinical settings and interventions to improve activity levels among older adults.
