Elder care

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For the first time in history, most people can expect to live into their 60s and beyond.

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The World report on ageing and health responds to these challenges by recommending equally pro found changes in the way health policies for ageing populations are formulated and services are provided.

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The recommended societal approach to population ageing, which includes the goal of building an age-friendly world, requires a transformation of health systems away from disease-based curative models and towards the provision of integrated care that is centred on the needs of older people.

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Throughout, examples of experi ences from different countries are used to illustrate how specific problems can be addressed through innovation solutions.

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A core group responsible for developing the conceptual framework and writing the report included Islene Araujo de Carvalho, John Beard, Somnath Chatterji, JoAnne Epping Jordan, Alison Harvey, Norah Keating, Aki Kuroda, Wahyu Retno Mahanani, Jean-Pierre Michel, Alana Officer, Anne Margriet Pot, Ritu Sadana, Jotheeswaran Amuthavalli Thiyagarajan and Lisa Warth.

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Chapter development was led by John Beard and Ritu Sadana (Chapter 1), John Beard and Jean-Pierre Michel (Chapter 2), John Beard and Somnath Chatterji (Chapter 3), Islene Araujo de Carvalho and JoAnne Epping Jordan (Chapter 4), Anne Margriet Pot and Peter Lloyd-Sherlock (Chapter 5) and Alana Officer and John Beard (Chapter 6).

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World report on ageing and health Mira Schneiders for coordinating the translation and printing; and Charlotte Wristberg for her administrative support.

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The World Health Organization also wishes to thank the governments of Japan and the Netherlands for their generous financial support for the development, translation and publication of the report.

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Yolande, 56, Haiti Yolande is the sole provider for her children, two grandchildren and a little boy who she took in because he needed care.

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A child born in Brazil or Myanmar in 2015 can expect to live 20 years longer than one born in those countries just 50 years ago.

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And, unlike most of the changes that societies will experience during the next 50 years, these underlying trends are largely predictable.

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Because the determinants of health in older age are being established even before we are born, this report applies a life-course approach (30, 31), but the focus of the report is on the second half of life.

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Inequities in health and pensions A review of health inequalities since 2010 in the United Kingdom found that while, on average, people could expect to live to age 77, 15 of these years would be spent with some form of disability.

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More than three quarters of people had experienced some form of disability by age 68, most of whom lived in poorer neighbourhoods.

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Ageism can take many forms, including prejudicial attitudes, discriminatory practices, or institutional policies and practices that perpetuate stereotypical beliefs (46).

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Yet ageism has been shown to cause lowered levels of self-efficacy, decreased productivity, and cardiovascular stress (50).

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This has been accompanied by shifts in intergenerational relations in almost all countries, but particularly in China, Japan, the Republic of Korea, Singapore and Thailand (71).

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Respect, obedience, loyalty and practical support are important components and may extend beyond immediate generations to encompass reverence for ancestors (for example, through ancestor worship and grave cleaning) (71, 72).

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At a biologi cal level, ageing is associated with the gradual accumulation of a wide variety of molecular and cellular damage (2, 3).

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Thus, while some 70-year-olds may enjoy good physical and mental functioning, others may be frail or require significant sup port to meet their basic needs.

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2.2, individual A can be consid ered as having the optimal trajectory, in which intrinsic capacity remains high until the end of life.

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Similarly, the pro vision of care in small-scale home-like facilities for people with dementia in the Netherlands has been shown to be related to a higher involve ment of residents in overall activities and their preferred activities (55).

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Zenul, Age unknown, Pakistan During the 2011 floods in Pakistan villagers lost their livestock and arable land was damaged.

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However, by the middle of the century, many countries will have a similar proportion of older people to that of Japan in 2012.

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Yet although the population structure in sub-Saharan Africa will stay young in relative terms, this region already has double the number of older adults than northern Europe, and this figure is expected to grow faster than anywhere else, increasing from 46 million in 2015 to 157 million by 2050 (1).

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Prior to recent advances in socioeconomic development, fertility rates in many parts of the world ranged from 5 to 7 births per woman (although many of these children did not survive into adulthood).

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In 2015, these rates have plummeted towards, or dropped below, the level needed to maintain pop ulations at their current size.

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One reason why is that productivity is difficult to measure objectively, with ratings by peers and supervisors often representing stereotypical conceptions rather than the actual performance of older workers (26).

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Overall, productivity does not seem to fall with age, although it may decrease as time spent in a particular job increases, with routinization leading to falls in motivation, or overuse leading to physical harm (27).

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By 2030, it is estimated that more than 75 mil lion people will be living with dementia, and the number is expected to triple by 2050.

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In one Australian study, it was estimated that around 10% of the expected increase in health-care costs during the next 20 years would come from demand for care for this condition alone (80).

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One common consequence is polyphar macy, which may be appropriate in terms of the individual conditions being treated, but places the patient at risk of adverse drug interactions and side-effects (94).

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However, the risk of drug interactions in comorbid and frail older people can limit the use of potentially beneficial phar macological therapies (96).

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3.18 uses aggregated SAGE data to explore the relationship between the vector of intrinsic capacity and socioeconomic status.

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The other 75% of this diversity is largely the result of the cumulative impact of behaviours and exposures during a person’s life course.

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Distance to retail stores and risk of being homebound among older adults in a city severely affected by the 2011 Great East Japan Earthquake.

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Margaret, 61, Tanzania Margaret, is a retired law enforcement officer, and struggled to adapt to her financial and social status after retirement.

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Data from SAGE, for example, showed that household wealth played an important part in determining health-care use among older Chinese and Gha naians: the higher a person’s wealth quintile, the more likely the person was to seek care (11).

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A priority pass card helps older people access health services in Kuwait In 2012, Kuwait implemented a simple but effective measure to improve the accessibility and delivery of health services to older people: it distributed a card granting priority access to older people to both general walk-in clinics and appointment-based chronic-disease management clinics.

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This gap is particularly impor tant in low- and middle-income countries, where these professionals are likely to form the front line in engaging with older people (Box 4.2).

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For example, costs are likely to be higher when death in hospital is the norm, although hospital admission may have little impact on clinical course and is unlikely to have benefits in terms of the well-being of those using more intensive services (41).

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Low protein intake is associated with a major reduction in IGF-1, cancer, and overall mortality in the 65 and younger but not older population.

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They are often presented as highly promising means for enhancing the functional ability of older people who have declines in their intrinsic capacity, for improving their quality of life as well as that of their caregivers, and for potentially reducing individual and societal costs and enabling ageing in place (49).

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During the later stages of dementia, however, this technology might not offer the same advantages and a different approach would need to be used (50).

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Their importance in promoting the well-being of older people, including those who are poor and disadvantaged, has been recognized by the Association of Southeast Asian Nations, the United Nations, WHO and governments throughout Asia (61).

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For example, Alzheimer’s Pakistan has established its first day centre for people who have dementia with technical collaboration from Alzheimer’s Australia in Western Australia (77).

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The centres provide care to people with dementia and other conditions, for example people who are recovering from strokes, 5 days a week (Monday to Friday) and also on certain Saturdays.

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Around 85% of the population is enrolled in these voluntary plans, including a relatively high proportion of older people.

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National Dementia Strategy, Scotland Scotland’s National Dementia Strategy: 2013–2016 has the following key outcomes (120).

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The strategy contributes to Scotland’s 2020 vision for health and care (121): that is, all people, including those with dementia, will be enabled to live well and longer at home or in home-like settings.

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105. [Ministry of Family and Social Policies, Turkey.] Evde Sağlık ve Sosyal Destek Hizmetlerinde Işbirliği Protokolü Imzalandı. [Cooperation protocol signed for home health and social support services.] In: T.C.

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106. [Ministry of Health, Turkey.] Evde Sağlık ve Sosyal Destek Hizmetlerinin Işbirliği İçerisinde Yürütülmesine Dair Protokol İmzalandı. [Implementation protocol for home health and social support services.] In: T.C.

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Once I was ready, the older people’s association gave me a grant of US$220 (880,000 Cambodian riels) to buy tools and an air pump- everything I needed to start fixing bicycles.

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Pervasive ageist stereotypes of older people as uniformly frail, burdensome and dependent are not supported by evidence (Chapter 1) and limit society’s ability to appreci ate and release the potential human and social resources inherent in older pop ulations.

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The WHO Global Network of Age-friendly Cities and Communities was established in 2010 to support municipalities that wished to transform these ambitions into reality, involving older people in the process and maximizing their opportunities at the local level.

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Between 2009 and 2014, more than 600 dangerous intersections were redesigned and pedestrian fatalities among older people decreased by 21% (4).

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In the United States, the financial abuse of older people is considered to be one of the fastest growing crimes, with older adults losing an estimated US$ 2.9 billion annually, and only 1 in 6 cases being reported (74).

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According to a large study on the financial abuse of older people in the United States, the most common perpetrators are not outsid ers, but family members (58%), most often the adult children of the older person (25%).

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Unlike younger adults – who may not see the impact of their negative behaviours until the future– older adults may see immediate and potentially life-threatening effects (100).

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The implications for health-promotion messages are as follows (118). ■ Use communication processes that rely on heuristics and intuition.

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Individual, social, and physical-environmental factors have been found to be equally important influences on the amount that older people walk (149).

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Environmental characteristics associated with increasing the physical activity of older people include providing safe spaces for walking (such as footpaths and parks); ensuring easy access to local facilities, goods and services; seeing other older people exercising in the same neighbourhood; and regularly participating in exercise with friends and family (149–152).

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During the past two decades, increasingly inclusive legislation has been passed, culminating in 2008 when Norway made inaccessibility a form of discrimination by introducing the Anti-Discrimination and Accessibility Act.

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In 2010 the act was extended to include the concept of universal design, and an action plan was developed that targeted the built environment, public transportation, the accessibility of information and technol ogy, and the refurbishing of municipal housing.

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Teams of 7–10 volunteers are assigned to each school, thus ensuring that sufficient volunteers are available to have an effect across all grades within the school.

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Benefits for participants compared with controls have shown: ■ an increase in physical strength and capacity (173, 174); ■ increased cognitive activity; ■ maintenance of walking speed; ■ improvements in social networks – that is, volunteers had people that they could turn to for help (174); ■ fewer depressive symptoms (173).

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Since 2006, more than 450 multigenerational centres have been established and subsidized by the German govern ment, creating an infrastructure for social cohesion in cities and communities across the country.

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python scripts/verify_primary_public_claim_group.py artifacts/cb7k_dom029_t07_primary_claims.json --source-file <local-raw-pdf>

As described in Chapter 2, fostering the functional ability that enables well-being in older age requires strategies aimed at building and maintaining intrinsic capac ity across the life course.

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To improve the health and well-being of older people in Khayelitsha – South Africa’s largest township and one of the poorest areas of Cape Town – 28 older community members were trained as peer supporters.

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Peer supporters had greater financial security because they were paid a salary comparable to government-employed community health workers for 20 hours per week.

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