Healthy aging

Eighteen out of the 20 countries in the world with the highest percentages of older people are in the European Region of WHO: in those countries, between 13.2% and 17.9% of the population are over 65 years old. Within the next 20 years, there will be a highly significant increase in the proportion of people in this age group, with the fastest growing population in most countries being those who are very old (i.e. aged 80 years and above). In the next 30 years, the proportion of people aged over 80 years (as a share of the over-65 population) will increase, in Europe as a whole, from 22% to over 30%.

Aging is a natural physiological process in which the body undergoes a series of changes. There is a very wide range of variation in terms of what this means for individuals and their ability to lead an active and fulfilling life. Many older people remain active and fully independent until very close to the end of their lives. Major threats to the health of older people are dementia, depression and suicide, cancer,

cardiovascular diseases, osteoporosis, incontinence and injuries.

This sub-chapter challenges some of the myths surrounding aging and points out how strategies to create safer communities and more supportive health and social policies and services can help older people.

Healthy aging: Although older people are more vulnerable to the above threats, they are by no means an inevitable part of the process of aging for everyone. In many parts of the Region, too much emphasis is placed on the decline of functions, too little on the opportunities to stay active. Little attention is paid to the health effects of declining social roles throughout the lifespan. Whereas adults have to shoulder multiple social and economic roles, they are often ill-prepared for a socially fulfilling life after regular employment comes to an end, children have moved out of the house and body functions are declining.

Much ill health is created through the misconception that aging is accompanied by inactivity, and that it only starts at the age of 65.

There are many opportunities to stay active and interested in life. Education levels of people aged 65 and above are increasing, and there are new opportunities for older people to continue education. In some countries, possibly as a result of higher levels of education, older people have established political

groupings and pensioner action groups to voice their demands in relation to the development of social and health policies and services. On a broad scale however, too few efforts are being made to meet the

changing needs and expectations of older people, and to prepare for an increasingly aging Europe.

Health and wellbeing of older women: Women are living longer than men, but these extra years are often accompanied by chronic illness, disability and difficulties in functioning independently, especially in the age group of the “old-olds”, (i.e. people aged 80 years and over). Dependence has physical, economic, psychological and social dimensions which have a powerful negative impact on the quality of life of the

very old, an age group of which women currently represent some 60–64%. One reason for the gender-based difference in functional ability may be that, as muscle mass becomes less, women fall below the

“critical threshold” earlier than men do.

Women tend to have fewer earnings and savings than men, a trend which is likely to continue over the next decade, with implications for public expenditure and women’s health and quality of life.

An environment and local community which promote healthy aging: The physical environment is an important determinant of older people’s ability to maintain their independence, both in their homes and when going out into the local community. Housing, transport and the design of local services are at present often obstacles to maintaining the functional levels of many elderly people, and a hindrance to sustaining their social networks. In particular, many transport systems in Europe cannot readily be used by older people; access to buses and subways is often poor.

Health and social care: Most older citizens want to stay in their homes as long as possible. However, there is a lack of appropriate home care services in a number of countries in the Region – especially for people with dementia. In many countries, older people do not have access to preventive care services.

Such services are very important for older people, however, as is illustrated by the very high demand for injury-related care. In general, rehabilitation has proved to be of great use in helping older people to lead independent lives and in increasing their autonomy and quality of life.

Older people consume a disproportionately large fraction of all prescribed drugs. In some countries, extensive drug use appears to be a substitute for the lack of rehabilitation services. Compliance in taking medicaments can be a big problem, especially for older people living on their own.

The current curricula for training health professionals are often based solely on medical treatment and hospital care; this contributes to the provision of considerable amounts of inappropriate services for older people in the Region.

TARGET 5. HEALTHY AGING

BY THE YEAR 2020, PEOPLE OVER 65 SHOULD HAVE THE OPPORTUNITY OF ENJOYING THEIR FULL HEALTH POTENTIAL AND PLAYING AN ACTIVE SOCIAL ROLE.

In particular:

5.1 there should be an increase of at least 20% in life expectancy and in disability-free life expectancy at age 65 years;

5.2 there should be an increase of at least 50% in the proportion of people at age 80 years enjoying a level of health in a home environment that permits them to maintain autonomy, self-esteem and their place in society.

Proposed strategies

Healthy aging: Health can be improved if European societies take active steps to change the negative image of aging, and if people in middle age have opportunities to slowly reduce their working commitments while increasing the social roles that they could carry on after regular employment has ceased. Older people are a great resource for their families and society, and they can make a large contribution to the quality of life and wellbeing of the family. Their experience and accumulated wisdom are invaluable assets in child-rearing and to other adults in the family, benefiting society as a whole and their immediate community long after they have ceased regular employment. However, this potential is rarely being fully exploited today.

Local communities: Older people need to be facilitated to take part in community and social activities. By working together, older people, their families, carers, the local community and NGOs can find innovative

ways to ensure that they continue to lead an active and interesting life. Such strategies may contribute to strengthening an older person’s capacity to cope with the loss of a spouse, family members or friends.

The physical environment should enable older people to participate in social networks and experience daily interaction with other people. Health can be improved if town planning and transport systems are designed with all potential users in mind, and if signposting is sufficiently large and clear to meet the needs of older people.

Health and social support: Given the demographic profile of European societies, social and other policies aimed at maintaining autonomy in old age and encouraging solidarity between the generations are

becoming ever more important. Policies are also needed to ensure an adequate income and subsidies to cover the costs of basic goods such as food and fuel, particularly in some eastern parts of the Region.

Effective integrated health and social policies are community-oriented, participatory, locally based and needs-led, and build on health assets. Case studies have shown that mobilizing cities and other local communities to improve health care and other services for older people is an effective strategy.

Health services: A large measure of independence can be maintained through the use of relatively low-cost devices and services. Systematic interventions to improve hearing, mobility (hip replacement), sight and chewing ability (dentures) may be of great benefit in terms of wellbeing, autonomy and activity and should receive much higher priority. The quality of life of older people and their families can be

improved, while dramatically reducing expensive care for this population group, if services are gender-sensitive and based on PHC; and if they reach out actively to every older person in the local community (e.g. through a family health nurse, see Chapter 6). Key service elements include an assessment of both the health needs and assets of each older person and his or her environment. If the older person wishes to stay at home, support should be given to adapt the home to his or her needs; home help should assist the older person in maintaining his or her autonomy. This should also be the prime goal of nursing homes.

Good coordination of health and social services in the community ensures continuity of care, supports people in their home environment as long as possible, and means that care institutions are used only when necessary.

Training curricula in PHC need to take much more account of the needs and assets of older people and be oriented towards the main goal of maintaining their autonomy. Such curricula should take account of the changing educational levels of future generations of older people, while reflecting their different

expectations of services for older people. Geriatric care is only one element and should not be overemphasized.

Opportunities for rehabilitation must be enhanced in many countries of the Region and made more easily affordable in some systems. Rehabilitation can be more cost-effective than keeping older people in hospitals. Homes offering care of the elderly should be based on the principles of maintaining their autonomy, self-esteem and civil status, and of gender sensitivity – women represent the majority of people living in such homes.

More appropriate health care and rehabilitation services could reduce the extensive drug use by older people. Where drugs are prescribed, the prescriber should consider the cost of the course of treatment, especially where elderly patients will have to pay for the drugs themselves. Containers should be labelled, and the size, shape, colour and appearance of tablets and capsules need to be appropriate for people who may have difficulties in taking medicaments.

HEALTHY AGING ON THE ISLAND OF SAMOS

A holistic support system for the elderly is being developed on the Aegean island of Samos which relies on community awareness among the islanders and cooperation between a number of different sectors. The aim is to ensure a better distribution of local resources and to provide a safe environment which promotes the emotional as well as the physical health of elderly people. The project will also benefit the tourist sector by promoting a healthy and safe environment to encourage elderly visitors to Samos, thereby generating income for the island which can later be ploughed back into improving services.

A support centre for the elderly where medical records would be held is to be set up. Any request for care from an elderly person or his or her carer will be transmitted to the appropriate professional (for example, nurses, pharmacists, social workers, physiotherapists, etc.) together with the appropriate information from his or her records. Requests for care can be made manually or automatically anywhere on the island using telematics (e.g. via personal mobile telephones and automatic paging and locating devices).

In Samos, carers are still generally people within the local community, family or neighbours. Initiatives such as

“elderly-friendly” shops, hotels, and restaurants, etc. make life easier for older people, both locals and visitors, and their carers. Other changes on the island include improvement to paths and street surfacing, the provision of ramps and handrails to improve the mobility of the elderly, better facilities, and shaded rest areas.

Source: Humphreys, P. Healthy aging on the island of Samos. Networking for health. Copenhagen, WHO Regional Office for Europe, 1996 (RHN Conferences Series, No. 4).