Dr Jane Barratt and Megan Acton, of the International Federation on Ageing, set out their vision of a Decade of Healthy Ageing from 2020 to 2030.
The International Federation on Ageing (IFA) is dedicated to a world in which the health, rights and choices of older people are both protected and respected. Central to delivering this is a commitment from policymakers, health professionals, employers and the public alike to create and maintain age-friendly services and societies that enable older people to not just live but live well. To this end, the IFA is hard at work alongside its 70-country-strong membership base to make a real difference to the lives of older people and promote a Decade of Healthy Ageing from 2020 to 2030.
Throughout its 45-year history, the IFA has been at the forefront of efforts to safeguard and prioritise the ageing population: it has played a crucial role in drafting key initiatives such as the United Nations Principles for Older Persons, which encourage governments to incorporate the independence, participation, care, self-fulfilment and dignity of older people into national programmes; it has actively advocated for older people to be recognised in the Sustainable Development Goals (Goal 3: Ensure healthy lives and promote wellbeing for all at all ages); and it continues to maintain a strong voice in the debate on how best to protect the rights of older people globally.
These efforts have seen it granted general consultative status at the United Nations and its agencies and also enter into formal relations with the World Health Organization (WHO).
Now, the IFA has set its sights on delivering the Decade of Healthy Ageing from 2020 to 2030 outlined in the WHO’s Global Strategy and Action Plan on Ageing and Health.
It is going about this in five main ways, namely by:
- Fostering healthy ageing:
- Developing systems for long-term care;
- Creating age-friendly environments;
- Securing decent work for older people; and
- Protecting the rights of older people.
Speaking to Health Europa, the IFA’s Dr Jane Barratt and Megan Acton set out the federation’s commitment to the Decade of Healthy Ageing goal, explain why healthcare systems must adapt, and quickly, to keep pace with the challenge of population ageing, and highlight the importance of intersectoral collaboration if a comprehensive and global response to healthy ageing is to be truly established.
This year’s IFA Global Conference centres on the theme ‘Towards a Decade of Healthy Ageing’ – how should the term ‘healthy ageing’ be understood?
The concept ‘healthy ageing’ is multifaceted and defined by the World Health Organization (WHO) as the ‘process of developing and maintaining the functional ability that enables wellbeing in old age’.1
Older people are at an increased risk of multimorbid chronic diseases, particularly those which are non-communicable diseases such as diabetes, cancers and respiratory conditions. In the Decade of Healthy Ageing we must aim to create an environment that maintains and enhances a person’s functional ability, therein enabling them to do what they value as opposed to what the health system and community assumes that they value.
In what ways are current models of care unsuited to dealing with the challenges of population ageing?
In the context of global population ageing, there is an urgent and critical need for governments around the world to re-evaluate and reform policies to both encourage healthy ageing and provide targeted care services. Older people are, however, not a homogeneous group and their impact over time has defied predictions. Collectively, they have unprecedented power with wide-ranging opportunities to contribute to society, yet also present the most complex challenges and concerns for government of all time.
As this major demographic transition occurs, an epidemiological transition will also be occurring, in which the burden of disease will continue to shift from infectious, communicable diseases to chronic, non-communicable diseases. Non-communicable disease in old age is a result of several factors such as smoking and alcohol use, poor diet, exposure to toxins, income, working conditions, education, unemployment and poverty.
The increase in the absolute number of people with chronic conditions presents an important challenge to healthcare systems, social care and government. While living longer should be celebrated by many older people, those over 85 years of age are more likely to use health services and long-term care extensively due to a corresponding decline in functional ability. The WHO World Report on Ageing and Health explains that the general trajectories of functioning can be divided into three common periods: a period of relatively high and stable capacity, a period of declining capacity, and a period of significant loss of capacity.1 These periods are not defined by chronological age, are not necessarily continually decreasing, and will differ markedly among individuals.
Furthermore, population ageing, migration and urbanisation have independently and collectively created a challenge for governments to determine how to create environments that are friendly across all ages. The ageing population is largely predictable, yet despite this knowledge most cities and governments have yet to put demographic changes on their agenda as a driver in planning an age-friendly environment that encapsulates transport, housing, outdoor spaces, social participation, respect and social inclusion, civic participation and employment, communication and information, and community support and health services.
How can a comprehensive and global response to healthy ageing be effectively achieved?
A comprehensive and global response to healthy ageing must be multifaceted in nature because of the heterogeneity of older people. The ageing population range in levels of inequity and health and have varying interests and values. Due to the complexity of an ageing population, the collaboration of various sectors and disciplines to mobilise and harness their diverse expertise and create new networks is critical.
Models of care are evolving at a rapid rate within and across countries, responding to the variation in requirements and care needs within acute settings as well as home and residential care. There will never be, nor should there be, a ‘gold standard’ but rather systematic development of service models that are rigorously evaluated. It is only through this routine process that forms of residential care can be developed that are not only sustainable from a business sense but provide the appropriate mix of family and formal care.
The IFA believes that a comprehensive global response to healthy ageing should be framed by a life-course perspective and oriented around functional ability and health promotion. A
life-course approach is crucial as it views health as an ongoing process throughout an individual’s lifespan. Engaging in health behaviours across the life-course can delay, limit or even prevent consequences of chronic diseases and functional decline.
Many governments have implemented preventative public health strategies to encourage healthy behaviours throughout life such as developing nutrition policies, implementing screening programmes and vaccine promotion, yet there is a lack of emphasis on older people. Successful examples to promote healthy ageing should be used by stakeholders to frame further strategies throughout the life-course to decrease or prevent chronic disease and functional decline.
Furthermore, older people with chronic conditions are at a higher risk of a range of health issues that can limit functional ability. To illustrate, adults with diabetes are at a higher risk for vaccine preventable diseases such as shingles, pneumonia and influenza, which can be largely prevented through adult vaccination. Therefore, adult vaccination is an example of an important element of a more comprehensive health promotion strategy to healthy ageing as vaccination can help reduce the burden of infectious diseases, decrease functional decline, and add healthy life years to older people, particularly amongst at-risk groups such as those with diabetes.
Individuals with diabetes are also at risk for diabetic retinopathy, an effect of diabetes on the eyes that can cause vision problems. Diabetic retinopathy can be prevented by encouraging people with diabetes to have their eyes checked and by ensuring healthcare professionals are appropriately educated and informed. Both vaccine-preventable diseases and diabetic retinopathy can decrease functional ability in later life, thus a global response to encourage healthy ageing should focus on at-risk groups such as this.
It has now been two years since the adoption of the WHO Global Strategy and Action Plan on Ageing and Health. What does the IFA make of these reports, and in what ways is the IFA itself working to support a Decade of Healthy Ageing from 2020 to 2030?
The WHO Global Strategy and Action Plan on Ageing and Health focuses on five strategic objectives:
- Commitment to action on healthy ageing in every country;
- Developing age-friendly environments;
- Aligning health systems to the needs of older populations;
- Developing sustainable and equitable systems for providing long-term care (home, communities, institutions); and
- Improving measurement, monitoring and research on healthy ageing.
The Global Strategy and Action Plan is a significant and much-needed step forward in establishing a framework for member states. The IFA, in its formal relations with the WHO, is strongly committed to contributing to the evidence and partnerships necessary to support a Decade of Healthy Ageing from 2020 to 2030 and has contributed in several ways.
To begin, the IFA works across sectors with the goal of improving uptake rates of adult vaccination. Infectious diseases are a main cause of morbidity and mortality amongst older people, despite being largely preventable through vaccination. Thus, immunisation is an underused platform that can be leveraged to deliver other critical health services along the life-course. The IFA has convened multiple high-level expert meetings across sectors with those in the field of ageing, immunology and public policy to put the issue of vaccine-preventable diseases on the agenda of many governments, which has led to the development of a World Coalition on Adult Vaccination.
The IFA has also contributed greatly to work on decreasing the risk of functional decline in later life through vision health. As people age, the incidence of vision loss is expected to increase. There are numerous causes of vision loss, including age-related macular degeneration, diabetic retinopathy and glaucoma. The IFA advocates directly to government and indirectly to specialist health professionals regarding the importance of coherent care pathways to improving access to vision health education, screening, and safe and effective treatment, through the national ‘Eye See You’ campaign. In addition, the IFA is leading a 41-country Diabetic Retinopathy Barometer Programme which:
- Encourages people with diabetes to have their eyes checked every one to two years;
- Ensures healthcare professionals are appropriately educated and informed about preventing and treating diabetic eye disease; and
- Informs and shapes national health policies to ensure eye care is a national priority and is accessible, affordable and timely for people with diabetes.
To address the importance of age-friendly environments to healthy ageing, the IFA has developed an interactive learning platform known as the Age-friendly Innovation Exchange (AFIX). AFIX aims to be a point of connection to enable knowledge exchange by creating opportunities for intersectoral dialogue, problem solving, and sharing opportunities to collaborate and partner in the field of age-friendly environments, allowing governments and key stakeholders to create environments better suited to the needs of all ages to increase the health and functional ability of older people.
Recently, the IFA and DaneAge convened the Copenhagen Think Tank and Summit to respond to a major gap in knowledge mobilisation around the topic of cognitive reserve. Finding initiatives that will maintain cognitive function and reduce cognitive decline in adults is imperative as peer-reviewed literature generally supports maintaining and increasing cognitive reserve as an effective buffer against cognitive ageing. Through the Copenhagen Think Tank and Summit, a deeper understanding was gained of potential cognitive reserve models and their benefits, and it was recognised that a reablement approach should be considered as a bridge between acute, long-term health and social care systems with the potential to help align these systems and save health dollars.
Lastly, the IFA 14th Global Conference ‘Towards a Decade of Healthy Ageing’, to be held on 8-10 August 2018, aims to enable older people to do what they value through a deeper evidence-based understanding of healthy ageing provided by conference delegates and speakers. The WHO Global Strategy and Action Plan were used by the IFA as a platform for the conference, with the goal of contributing to the evidence and partnerships necessary to support a Decade of Healthy Ageing from 2020 to 2030.
- World Health Organization. World Report on Ageing and Health. World Health Organization, 2015
Dr Jane Barratt, Secretary General
Megan Acton, Project Officer
International Federation on Ageing
This article will appear in issue 6 of Health Europa Quarterly, which will be published in August.