"Groningen works on healthy ageing"

Ageing is more critical in the Northern Netherlands than in other parts of the country. How does Groningen deal with this? And what role have the RUG and the UMCG?

Leo van Wissen: “The mortality rate is slightly higher and the birth rate is slightly lower in the north, compared to the rest of the Netherlands. But that does not explain the population decline in the Northern provinces. This population decline is mostly caused by selective migration of mostly young people to the city. Youth from all rural communities tend to leave to establish themselves in cities. Such selective migration enhances ageing, which means that ageing occurs even more in those areas where young people are leaving to a city to study and work. In some shrinking regions, the share of 65+ will rise above 30% by 2035, while this rate is close to 25% nationally. This trend will lead to a shortage of workers in health care in these regions and will put a lot of pressure on the facilities for the elderly. The consequence for Groningen is that the city becomes “a growing island in a stagnating region”. In the surrounding villages, the facilities for education, health care and shopping will drop tremendously. These services will be more concentrated in the larger cities, like the city of Groningen.

The position of the UMCG as a large regional healthcare centre will necessarily be strengthened. Besides, as services in the rural surrounding areas of cities disappear, it is important that the central function of a city will be reinforced. This applies to facilities, arts, culture, education, as well as employment. At first sight, this looks positive; however there is also a disadvantage. The University for instance has strong regional roots. Youth from the Northern provinces leave their hometown to study in. But if the number of young people in the region is falling, the inflow will decrease accordingly. To the University it is important to explore new student markets (both nationally as internationally) to maintain its position in the Netherlands.Therefore the city of Groningen invests in a good living environment for students and launched its “City of Talent” campaign some years ago”.

With whom is University Medical Centre Groningen cooperating to deal with demographic challenges?

Erik Buskens: “The city of Groningen, the RUG, Hanze University of Applied Sciences Groningen and the UMCG joined forces in 2005 in the Groningen Agreement (Het Akkoord van Groningen). By acting together on the basis of a single vision and a common agenda, the partners in the Agreement intend to further develop Groningen as a city of knowledge and innovation. The priority areas are energy and healthy ageing. The latter comprises LifeLines, a unique biobank and cohort study, which will follow 165,000 Northerners of three generations for at least 30 years. (Un)healthy ageing may be deciphered yielding innovative care solutions for people who want to live independently, such as vulnerable older people. Such expertise will be transferred in training programmes known as the very best in their field and will attract students from all over the world. Also the newly gained knowledge will be converted into cash through quality products and the patents that go with them. The social consequences of the ageing population are rapidly demanding more knowledge. Worldwide only a few research institutes focus exclusively on ageing. This is why the UMCG and the RUG are investing in the European Research institute on the Biology of Ageing (ERIBA). A brand-new building will be built in Groningen, equipped with all the facilities needed for top-level research. From 2011 onwards, renowned international scientists will work here. They will reveal fundamental mechanisms which cause age-related diseases. Through the collaboration which has already been initiated with other leading international research institutes, sufficient focus and mass will be achieved to reach significant scientific breakthroughs. ERIBA’s research results will provide the knowledge required for the development of effective prevention and treatment methods for age-related diseases. Commercial applications will follow: new products and methods for screening, diagnosis and treatment, new medicines and innovative dietary products”.

How did the mission ‘building the future of healthcare’ develop? What does it entail?

Erik Buskens: “As a leading center for patient care, training and medical scientific research; the UMCG is eager to contribute toward resolving the problems that the Dutch healthcare sector is facing. The Ministry of Health, Welfare & Sports categorized these problems under five major social themes: preparing for an increasing and ever-changing demand for acre; living longer in food health; maintaining quality and patient safety; limitations on care and dealing with shortfalls and risks; as well as speeding up the development and implementations of innovative medical products. The UMCG aims to play an active role with respect to all these issues. UMCG has a long standing tradition when it comes to fundamental and patient-oriented scientific research into chronic diseases and ageing. This expertise, combined with over 200 years of experience in patient care, will be applied so that the treatment of patients with complex needs can be tailored to the individual. Further investments in knowledge in the field of ageing will produce economic growth and new products which, in turn, will help ensure that a healthier population can live independently for longer. The UMCG is contributing to improvements in the field of prevention, quality of care and innovation and is thus “building the future of healthcare”.

Erik Buskens: “Several multidisciplinary groups have been conceived preparing for a transition in elderly care. An ageing population will present itself with very different demands. Elderly patients will require care that takes into account several chronic conditions that cannot be cured simultaneously and the treatment goal will to a large extend have to be self sufficiency and well being.

The Ageing Brain group addresses fundamental processes of ageing at cellular level but also is developing a hospital wide program on recognition of (mild) cognitive impairment and prevention of delirium. Likewise many disciplines represented in Onco-lives advocate a new approach and vigilant long-term follow-up and of survivors of malignancies. Also, clinical geriatrics in collaboration with several related disciplines currently is part of the University Center for Elderly Care (UCO) and has widened its scope and is offering broad consultation for complex elderly patients. Other examples of important initiatives focusing on COPD (GRIAC), childhood obesity and conduct disorders may be mentioned. Finally, UMCG participates is a National Program for Elderly Care funded by the Netherlands Organisation for Health Research and Development (ZonMw) and has set up a network comprising the three Northern provinces. As transition projects addresses frailty and care, it needs to develop demand rather than supply driven care and prevention. Notably, many municipalities with specific obligations to support and maintain self-sufficiency also participate in the transition project. Other projects focus more on malnutrition and dementia in primary care.

The above initiatives share a common view that future health care should adopt a broad view on life-long health maintenance. Health professionals should actively think about the paths leading to disease and functional loss and develop and evidence preventive life style interventions. Also, should disease occur, this should be treated with the patients’ goals and expectations in mind. Particularly, the remaining life years with optimal functioning and self sufficiency should be aimed for. UMCG is adopting this novel orientation and is taking regional and National responsibility for the transition required.

Currently, actual results can not yet be presented. However, as forerunners we expect to present the first results within the next two to three years”.

What are the benefits of these initiatives for (elderly) citizens?

Erik Buskens: “The Ministry of Health, Welfare & Sports, has requested the eight UMCs to set up the National Programme for care for the Elderly. The UMCG hasthe lead in setting up a‘National Programme for care for the Elderly - North (NPO-North)’. The overall objective of the NPO North is to create added value, i.e. improvements in care, welfare and housing for older people who suffer from complex disorders. The activities of the network focus on strengthening and embedding tailored, comprehensive care. Aiming at greater self-reliance, job retention and higher quality of life.The initial focus of this program is identifying specific care issues and needs of the elderly. Through knowledge creation, the possiblities of improvement of health care for frail elderly will be identified. Elderly are continuously being consulted and are a true stakeholder.

Partners include: GP, peripheral hospitals, nursing homes, home care organisations, pharmacists, mental health organisations (GGZ), elderly or patients regional organisations, welfare and health care organizations, insurance companies, municipalities and companies working in the field of social support”.

What should the EU do to improve UMCG’s work in elderly care?

Erik Buskens:“The European Union should also recognize the challenges ahead and take on the responsibilities. The centers of excellence should be supported with recognition and allowed to collaboratively comprehend healthy ageing and develop effective and efficient health and preventive programs. The European community may set an example and maintain its position as region of knowledge and development”.

Leo van Wissen: “Around 2035 the (Dutch) population is expected to decline. This evolves very slowly though: in 2050 we will still have more people in the Netherlands than presently. Population decline occurs earlier in the Northern provinces, however the consequences will be moderate. The three Northern provinces will only start to shrink around 2035. Yet, in the North there exist great differences: a strong and growing urban centre: city of Groningen, and shrinking surrounding areas. These shrinking surrounding areas include on the one hand regions where shrinking started later and more moderate. On the other hand, it includes extremely shrinking regions such as Eastern Groningen, where structural shrinkage occurs for a long time in history, in which the number of households, and consequently dwellings, falls. A small village in the North, Delfzijl, for example, will lose a quarter of its population until 2035. So for the entire North, population decline is more a local problem than a structural problem. The more attractive towns (municipalities) in the North are still able to compensate the outflow by attracting middle age and older households. In many towns this compensating migration flow does not exist (anymore)”.