NIHR GRP: Healthy Ageing in Sub-Saharan Africa The NIHR Global Research Professorship (GRP) scheme is open to all professions and all Higher Education Institutions (HEI), based in UK and low-and-middle-income-country (LMIC), to nominate health researchers and methodologists with an outstanding research record of clinical and applied health research and its effective translation for improved health. Global Research Professors are required to have existing strong collaborations or links with collaborators or partners in institutions in countries on the OECD DAC list and the award should plan to strengthen these/support training and capacity development/mentorship in these partners.

Thanks to advances in health and sanitation, around the world people are living longer than ever before, with the greatest changes happening in Africa. In these added years of life, older people understandably want health and wellbeing, that is ‘healthy ageing’. However, currently many African countries, with challenged healthcare services and limited resources, are struggling to provide for their rapidly ageing populations, meaning older people are more likely to be living with disability and dependence. The World Health Organization (WHO) describes healthy ageing as an older person’s ability to walk, see and hear, and function mentally within the place they live. As countries develop health services to meet the growing needs of ageing populations, there is an opportunity now to proactively plan innovative ways of providing healthcare to help people age well. I have an established research network across The Gambia, South Africa and Zimbabwe on which to build this research programme. I want to understand why some people age healthily and some ‘unhealthily’ in these three very different countries, and then develop a ‘Healthy Ageing Check-up’, run by nurses and therapists in local communities, where older people can be assessed and offered practical management to maintain health as they age. Initially my team and I will analyse information collected from 5030 older adults across the three countries, to understand how commonly people are ageing healthily (and unhealthily), and how this influences quality of life. We will then look at what diseases particularly pre-dispose someone to unhealthy ageing, which we should address in our healthy ageing check-ups. State-of-the-art blood tests for molecules reflecting how our bodies work, will help us understand the underlying processes behind how these diseases affect the way we age.

We will then work with a range of stakeholders, healthcare experts and older people themselves, to develop a health check-up for people aged 65 years and older, that we will test in Zimbabwe. The check-up will assess for example, walking, balance, nutrition, memory, mood, eyesight, and hearing. We expect most older people will have problems in several areas. When we identify a problem we will offer advice, practical solutions and if needed arrange specialist referral. We will test how well the roll-out of this system of health checks works, for example how often we identify a health problem, how often we can offer a solution and, when we follow them up again after 4 months, how frequently the older person has taken up the recommendations. In theory access to public healthcare is free to older people in Zimbabwe. As well as calculating how much it costs to provide the health check-ups and care, we will see if people experience extra ‘out-of-pocket’ costs because of the health checks, and if so, the reasons for this. 
Finally, working with the WHO, we will develop a ‘Healthy Ageing Intervention Toolkit’ to guide the structured, comprehensive, person-centred assessment and management of older people, ready for scale-up across sub-Saharan Africa.
Over the 5 years, I will grow a highly-skilled and experienced Global Health and Ageing Research team to ensure positive impacts on older people’s health for many years to come. 1. To evaluate ‘healthy ageing’ in three diverse settings in sub-Saharan Africa (The Gambia, Zimbabwe, South Africa):
a. Quantifying healthy ageing and generating T-Scores to enable rural-urban and inter-country comparisons.
b. Understanding associations between healthy ageing and key outcomes including health-related quality of life (HRQoL), food insecurity and household wealth
c. Determining drivers of ‘unhealthy ageing’, particularly multimorbidity clusters that associate with adverse ageing profiles
d. Describing the metabolomic ‘signatures’ of healthy and unhealthy ageing in these three diverse populations.

2. To develop a healthy ageing screening and intervention programme for community-dwelling older adults which addresses challenges to functional ability.

3. To determine the feasibility, acceptability, effectiveness and costs of introducing community-based health checks of functional ability for older people in Zimbabwe.

4. Through community engagement and involvement (CEI), co-design and implement community-based healthy ageing peer-to-peer support groups, to promote and maintain functional ability by facilitating self-management.

5. To develop a ‘Healthy Ageing’ Intervention Toolkit guiding a structured, comprehensive, person-centred approach for non-specialist assessment and management of functional ability in older people living in sub Saharan Africa.