1 Recommendations

Promoting healthy lifestyles

1 Encouraging healthy behaviours

National organisations and local government departments that influence public health should continue to:

  • Develop and support population-level initiatives to reduce the risk of dementia, disability and frailty by making it easier for people to:

    • stop smoking

    • be more physically active

    • reduce their alcohol consumption

    • adopt a healthy diet

    • achieve and/or maintain a healthy weight.

  • Use the local regulatory options and legal powers available to encourage increased adoption of healthy behaviours, and risk reduction. For example, as outlined on websites such as Healthy Places.

  • Make physical activity, adopting a healthy diet and achieving and maintaining a healthy weight as accessible, affordable and acceptable as possible.

2 Integrating dementia risk reduction prevention policies

Public Health England, NHS England, relevant national third‑sector organisations and health and social care commissioners should:

  • Include dementia in strategy documents aimed at preventing other non‑communicable chronic conditions (for example cardiovascular disease, type 2 diabetes, stroke and chronic obstructive pulmonary disease) see NICE's guideline on preventing type 2 diabetes: population and community-level interventions.

  • Make it clear that some common unhealthy behaviours can increase the risk of dementia and that addressing those behaviours will reduce the likelihood of developing dementia and other non‑communicable chronic conditions.

  • Ensure interventions and programmes to prevent non‑communicable chronic conditions state that the risk of dementia can be reduced by encouraging healthy behaviours (see recommendation 1), including reducing loneliness, by leading a physically and mentally active life.

3 Raising awareness of risk of dementia, disability and frailty

Public Health England, Health Education England and NHS England should:

  • Commission national, regional and local campaigns aimed at the public and health and social care professionals to show how the risk of dementia, disability and frailty can be reduced and to promote the concept of keeping mentally and physically healthy. Campaigns should use a range of media and formats to reach as many people as possible. See NICE's pathway on preventing type 2 diabetes: population and community interventions.

  • Use the campaigns to provide messages such as:

    • Sustained ill health in old age is not inevitable. The risk of developing dementia, disability and frailty may be reduced and, for some, onset can be delayed and the severity of the conditions reduced.

    • Smoking, lack of physical activity, alcohol consumption, poor diet, being overweight or obese and loneliness are all avoidable risk factors for dementia, disability and frailty.

    • The earlier in life that healthy changes are made, the greater the likelihood of reducing the risk of dementia, disability and frailty.

    • There are health gains that can be made by changing behaviours even in mid‑life.

    • Healthy behaviours are more likely to be maintained if they are built into everyday life.

  • Ensure messages do not stigmatise people by suggesting that people who develop dementia, disability or frailty are at fault. Tell people that although some important risks can be reduced, there may be others such as genetic susceptibility that cannot be changed. It is still worth reducing risks where possible, even if there are unmodifiable risks, as this can increase the years spent in good health.

4 Producing information on reducing the risks of dementia, disability and frailty

Public Health England and NHS England should produce detailed information to promote specific behaviours that can improve someone's health and discourage those that can lead to poor health in later life. For example, it should:

  • Encourage smokers to quit or use harm reduction measures by highlighting the immediate and long‑term benefits. In particular, make it clear that there is a link between smoking and dementia, disability and frailty.

  • Show how a wide range of domestic, leisure and work activities can help people to be physically active and explain how even modest increases in physical activity, at any age, can be beneficial. Include information on how physical activity:

    • reduces the risk of illness in both the short and long term, preserves memory and cognitive ability, reduces risk of falls and leads to a healthier old age, improving wellbeing and quality of life

    • is enjoyable and can have social benefits

    • should be a part of everyday life for a person's whole life course.

  • Explain that alcohol consumption can increase the risk of dementia, disability and frailty and encourage people to reduce the amount they drink as much as possible.

  • Explain that regularly consuming meals, snacks and beverages high in salt, fats and sugars is bad for health.

  • Explain that a diet mainly based on vegetables, fruits, beans and pulses, wholegrains and fish, is likely to improve their health (see NICE's pathway on diet).

  • Advise people to aim to maintain a healthy body weight (see NICE's pathway on overweight and obese adults – lifestyle weight management).

5 Preventing tobacco use

Local government, Public Health England, NHS England and the National Trading Standards Board should continue to develop, deliver and enforce comprehensive local tobacco control strategies, in line with current policy. They should:

Local authorities and clinical commissioning groups should continue to commission smoking cessation services (see NICE's pathway on smoking) and promote quitting as the best way to reduce the risks from tobacco. Services should include strategies to encourage smokers who may not be able to quit, or who do not want to quit, to switch to less harmful sources of nicotine (see NICE's pathway on tobacco: harm-reduction approaches to smoking).

6 Improving the environment to promote physical activity

Local government, local enterprise partnerships, transport professionals and other organisations involved with the built and natural environment or with road safety (see who should take action?), should improve environments where people live and work to encourage and enable everyone to build physical activity into their daily lives. This should include:

  • Using new and existing traffic management and highway schemes to make walking and cycling safe and attractive options (see NICE's pathways on physical activity and the environment and walking and cycling).

  • Improving the existing built environment, and designing new developments, to promote physical activity (see NICE's pathway on physical activity and the environment).

7 Reducing alcohol‑related risk

Local government, Public Health England, the National Trading Standards Board and licensing authorities should continue to develop and implement guidance and policies to reduce alcohol consumption across the population. They could include:

  • Making alcohol less accessible, affordable and acceptable (see also NICE's guideline on alcohol-use disorders: preventing harmful drinking).

  • Continuing to work to prevent illicit alcohol sales (see also recommendation 3 in NICE's guideline on alcohol‑use disorders: preventing harmful drinking).

  • Making best use of local information such as alcohol‑related injuries and crime, to develop the local alcohol strategy. For example, use early morning restriction orders, the late night levy, designated public place orders and the cumulative impact policy as necessary to reduce alcohol related harm (see also recommendation 2 in NICE's guideline on alcohol‑use disorders: preventing harmful drinking).

  • Ensuring plans include screening and brief interventions for people at risk of an alcohol‑related problem (hazardous drinkers) and those whose health is being damaged by alcohol (harmful drinkers) (see NICE's guideline on alcohol‑use disorders: preventing harmful drinking).

8 Supporting people to eat healthily

Local government, Public Health England and NHS England should help and support people to eat healthily by:

Service organisation and delivery

9 Delivering services to promote behaviour change

Public Health England, commissioners, local authorities, providers of NHS services, NHS Health Checks and other providers of behaviour change programmes should:

  • Ensure programmes to prevent non‑communicable chronic diseases share resources and expertise nationally and locally to maximise coverage and impact (see NICE's pathways on preventing type 2 diabetes: population and community interventions and behaviour change: individual approaches).

  • Work together to deliver services that address the needs of people with multiple risk factors as well as for those with single risk factors.

  • Emphasise the need for, and help people to maintain, healthy behaviours throughout life (such as stopping smoking, being physically active, drinking less alcohol, eating healthily and being a healthy weight).

  • Help people identify and address their personal barriers that prevent them from making changes to improve their health.

  • Make information and services available to all (see the Equality Act 2010). Additionally, target these towards those with the greatest need whenever possible.

  • Develop the NHS Health Check programme to promote opportunities in mid‑life to reduce the behavioural risk factors for dementia, disability and frailty by:

    • tailoring the advice component of the NHS Health Check programme for different age groups

    • adding dementia prevention advice to all health checks.

  • Use audit to help improve the effectiveness of services.

10 Providing accessible services

Commissioners and providers of local services should:

  • Work with local communities to understand the range of services that they need to reduce the risks of dementia, disability and frailty.

  • Provide services at convenient times and in easily accessible places. They should offer some outside office hours, and some in workplaces and community settings (for example, community and faith centres).

  • Provide digital services to complement traditional services when appropriate.

  • Provide information in a range of languages and culturally acceptable styles, and offer translation and interpretation facilities if appropriate.

11 Providing advice on reducing the risks of dementia, disability and frailty at every appropriate opportunity

Public and third sector providers (such as local authorities, leisure services, emergency services and health and social care providers) should:

  • Use routine appointments and contacts to identify people at risk of dementia, disability and frailty (for example, appointments with a GP or practice nurse, when attending leisure centre classes, or visiting a community pharmacy).

  • Take advantage of times in people's lives when substantial change occurs. (Examples include: retirement, when children leave home, when starting to care for older relatives or grandchildren, or during the menopause.) These are times when people may consider adopting new healthy behaviours, or may be at risk of adopting unhealthy ones.

  • Whenever the opportunity arises give people advice on how to reduce the risk factors for dementia, disability and frailty or refer them to specialist services when necessary (see recommendation 9 in NICE's guideline on behaviour change: individual approaches).

12 Providing physical activity opportunities

Local authorities and third‑sector organisations with a responsibility for, or who support, public health services should:

  • Encourage both recreational activities and active travel (for example, walking, cycling) for local journeys.

  • Provide supervised activities and exercise classes and an infrastructure to support walking and cycling. They should also maintain parks and open green spaces. The aim is to help people in mid‑life to be physically active in different ways – and at different levels of intensity (see NICE's pathways on physical activity and walking and cycling).

  • Ensure that venues provide easily accessible information for visitors using forms of active travel, such as cycle parking locations and links to local online journey planners and mapping (See NICE's pathway on walking and cycling).

  • Publicise these opportunities, including where they can be found and who to contact for more information (see NICE's pathways on physical activity: brief advice for adults in primary care, behaviour change: individual approaches and risk identification and interventions for individuals at high risk in NICE's pathway on preventing type 2 diabetes).

13 Provide training

Training commissioners and providers should:

  • Commission or provide training and continuing professional development programmes for local authority staff, all health and social care professionals, relevant third‑sector staff and community volunteers to help to reduce the risk factors for dementia, disability and frailty in later life. Training should include how to identify people at most risk and how to advise and support people to change behaviour (see NICE's pathway on behaviour change: individual approaches).

  • Train participants to provide brief advice and when and how to refer people to other services to address behaviour change.

  • Help participants reduce their own health risks, if necessary, by changing their own behaviour (see recommendation 10 in NICE's guideline on tobacco: harm‑reduction approaches to smoking and recommendation 13 in NICE's guideline on smoking cessation in secondary care: acute, maternity and mental health services; also see NICE's pathway on physical activity: brief advice for adults in primary care).

14 Leading by example in the public sector

Public sector organisations should:

  • Set an example by ensuring their procurement, commissioning and other policies encourage and support healthy living. For example by:

    • specifying the need to encourage a healthy diet in contracts for on‑site cafes and shops

    • by restricting foods high in salt, saturated fat, artificial trans fats and free sugars and drinks high in sugar

    • by providing resources and support to help employees make behavioural changes (see recommendation 15).

15 Providing support in the workplace

All employers should:

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