WHO on ageing and health
WHO
Populations around the world are rapidly ageing, with some of the fastest change occurring in low and middle income countries. Promoting healthy and active ageing, and building systems to meet the needs of older adults, will be central to fostering healthy ageing in every country.
Facts about ageing
The world population is rapidly ageing
Between 2000 and 2050, the proportion of the worlds population over 60 years will double from about 11% to 22%.
The absolute number of people aged 60 years and over is expected to increase from 605 million to 2 billion over the same period.
Low- and middle-income countries will experience the most rapid and dramatic demographic change
It took more than 100 years for the share of Frances population aged 65 or older to double from 7 to 14%. In contrast, it will take countries like Brazil and China less than 25 years to reach the same growth.
The world will have more people who live to see their 80s or 90s than ever before
The number of people aged 80 years or older will have almost quadrupled between 2000 and 2050 to 395 million. There is no historical precedent for a majority of middle-aged and older adults having living parents, as is already the case today.
More children will know their grandparents and even their great-grandparents, especially their great-grandmothers. On average, women live six to eight years longer than men.
How well we age depends on many factors
The functional capacity of an individuals biological system increases during the first years of life, reaches its peak in early adulthood and naturally declines thereafter.
The rate of decline is determined, at least in part, by our lifestyle and environment throughout life. Factors include what we eat, how physically active we are and our exposure to health risks such as those caused by smoking, harmful consumption of alcohol, or exposure to toxic substances.
Even in poor countries, most older people die of non-communicable diseases
Even in poor countries, most older people die of non-communicable diseases such as heart disease, cancer and diabetes, rather than from infectious and parasitic diseases. In addition, older people often have several health problems, such as diabetes and heart disease, at the same time.
Globally, many older people are at risk of maltreatment
Around 6% of older people in developed countries have experienced some form of maltreatment at home. Abusive acts in institutions include physically restraining residents, depriving them of dignity (by for instance leaving them in soiled clothes) and intentionally providing insufficient care (such as allowing them to develop pressure sores).
The maltreatment of older people can lead to serious physical injuries and long-term psychological consequences.
The need for long-term care is rising
The number of older people who are no longer able to look after themselves in developing countries is forecast to quadruple by 2050.
Many of the very old lose their ability to live independently because of limited mobility, frailty or other physical or mental health problems.
Many require some form of long-term care, which can include home nursing, community care and assisted living, residential care and long stays in hospitals.
As people live longer, worldwide, there will be a dramatic increase in the number of people with forms of dementia such as Alzheimers disease
The risk of dementia rises sharply with age with an estimated 25-30% of people aged 85 or older having some degree of cognitive decline. Older people with dementia in low- and middle-income countries generally do not have access to the affordable long-term care their condition may warrant. Often their families do not often have publicly funded support to help with care at home.
In emergency situations, older people can be especially vulnerable
When communities are displaced by natural disasters or armed conflict, older people may be unable to flee or travel long distances and may be left behind.
Yet, in many situations they can also be a valuable resource for their communities as well as for the humanitarian aid process when they are involved as community leaders.
Fighting stereotypes
Ageism
We all generally value and respect the older people we love or know well. But our attitudes to other older people within the broader community can be different.
In many traditional societies, older people are respected as elders. However, in other societies, older women and men may be less respected.
The marginalization can be structural, for example enforced retirement ages, or informal, such as older people being viewed as less energetic and less valuable to a potential employer.
These attitudes are examples of ageism - the stereotyping of, and discrimination against, individuals or groups because of their age. Ageist attitudes can portray older people as frail, past their sell-by date, unable to work, physically weak, mentally slow, disabled or helpless. Ageism serves as a social divider between young and old.
Stereotypes
These stereotypes can prevent older men and women from fully participating in social, political, economic, cultural, spiritual, civic and other activities.
Younger people may also influence these decisions in the attitudes they convey to older people, or even by building barriers to their participation.
Ageist stereotypes can also prevent us meeting the challenges of population ageing since they can prevent us asking the right questions or finding innovative solutions.
What WHO is doing
Strengthening primary health care
Quality, safety and access issues for primary care for older people, including the early detection and management of common conditions like hypertension and diabetes, are not well understood. WHO will work to identify strategies that can enhance existing efforts to strengthen health systems to make services more effective and more accessible for older people, particularly in low- and middle-income countries.
For example, the focus of WHOs prevention of blindness programme will aim to provide technical capacity to countries to help them tackle age-related chronic eye disease such as cataract, diabetic retinopathy, glaucoma, age related macular degeneration and uncorrected presbyopia.
The WHO programme for the prevention of deafness is supporting governments to develop comprehensive national plans for ear and hearing health. Age-related hearing issues need to be a central component of these plans.
Harnessing technology
Innovation and technology can help older people in many ways: to better monitor health status and detect early signs of disease; connect older people to health care; underpin new approaches; ensure better data collection and monitoring; create training opportunities for health workers and caregivers; develop new versions of diagnostic, monitoring and assistive devices; and to assist older people with functional loss to remain independent.
We need to encourage these developments, but also to remember that the majority of older people live in less developed countries. Fostering the development/adaptation and transfer of appropriate technology and innovative solutions to these settings can help us achieve health equity. A WHO steering group has been established to turn this vision into reality.
Building the skills for the 21st century health workforce
New curricula are needed to ensure that the global workforce has the appropriate skills to deal with the older populations that will form the bulk of their practice. WHO has undertaken an initial global review of medical curricula. This identified a number of possible approaches for making university training more relevant to the needs of older populations.
WHO will be looking to partner organizations to develop these further and provide guidance for universities in developing their curricula in a way that will most effectively meet the workforce needs of the 21st century.
Rehabilitation and long-term care
Improving functioning through rehabilitation
One common consequence of non-communicable diseases is loss of function leading to the eventual inability of an older person to remain independent. Evidence suggests that rehabilitation can reduce these problems, shorten hospital stays and improve quality of life.
Supporting long-term care
Information about the best models of long-term care in both developed and developing countries is limited. Gaps include information on quality, access and safety. We also need to understand better how to support the formal and informal carers who look after people at the end of life or when functional decline has caused a loss of independence.
Guidance on frailty
Frailty is an important and complex issue that is often associated with loss of independence, a need for long-term care and significant strain on families.
WHO is working with the 10/66 Dementia Research Group, Kings College, London and the Public Health Foundation for India to develop guidance and a new intervention package for frail, dependent older people in resource-poor settings.
The intervention will target undernutrition, immobility, incontinence, falls, hearing and visual impairment and neuropsychological impairments (cognitive, behavioural and psychological problems).
Providing palliative care
Palliative care should be available for all patients with life-threatening illnesses. Yet millions of older people continue to die in unnecessary distress and pain, simply due to lack of access to appropriate medication and support.
WHO will work to provide recommendations on how countries can effectively integrate palliative care into their health systems, across disease groups and levels of care, to ensure the most efficient provision of palliative care and the best coverage for patients.
In addition, we will work to develop guidance on what constitutes safe, high quality end-of-life care and look to develop technologies that facilitate such care, in partnership with nongovernmental and private sector leaders.
Improving care and services for people with dementia
WHO launched the Mental Health Gap Action Programme (mhGAP) in 2008 with the aim to expand care and services for people with mental and neurological disorders including dementia. Within mhGAP, an evidence-based intervention guide provides simple flow charts for management of people with dementia in primary health care by non-specialized health-care providers.
Visual impairment
A new WHO strategy for tackling the problems of blindness and visual impairment will be set out for 2014-2019. A major component will be preventing and treating chronic eye disease, of which older people are at greatest risk. WHO will continue to promote comprehensive integrated eye-care services in countries by working with governments and international partners, for example through workshops dealing with prevention of blindness. WHO will continue to address refractive errors, currently the leading cause of visual impairment in the world, by enhancing country capacity to provide affordable eye glasses and ensure older people have access to services.
In addition, WHO will be reporting on the results of research into presbyopia in a number of countries. WHO will continue to promote affordable high-quality surgical services for removing cataracts, which are currently the leading cause of global blindness in older people.
A new programme for better understanding diabetic eye disease is currently being developed within WHO. In addition, WHO is preparing a technical report on public health interventions for chronic non-communicable eye diseases.
Deafness and hearing impairment
In 2012 WHO re-established its prevention of deafness and hearing impairment programme. Over the next two years WHO will work with selected countries to strengthen the prevention and control of hearing disorders within primary health care. It is important to focus on access to services for older people as this group is particularly susceptible to hearing loss. As with the prevention of blindness and visual impairment, WHO will promote primary health-care services within the context of comprehensive health care and a robust health system.
Oral health
Poor oral health is common in older people worldwide. Tooth decay and lack of dental care, severe gum disease, tooth loss, ill-fitting dentures, dry mouth, oral cancer, oral pain and discomfort, and limitation of oral and social functioning are conditions that impair quality of life.
Chronic disease and poor oral health are linked indirectly due to common risk factors for non-communicable diseases; directly, tooth loss is due to poor nutrition whereas gum disease is linked with diabetes. Mouth problems are frequent in low- and middle-income countries while inequalities are huge globally.
Older people are underserved due to the high cost of care, and poor availability and accessibility of oral health services. WHO has developed guidelines for age-friendly primary oral health care, in support of national capacity building, and orientation of oral health systems towards disease prevention and health promotion. Oral health actions are part of non-communicable disease prevention and general health promotion; oral health of older people is promoted through strengthening of outreach health systems.
Ensuring medication safety
One key risk for older people is the inappropriate use of medication. WHO is developing a clinical package including medication prescribing protocols, a patient approach to empower older patients to manage their own medications and a community approach to raise awareness and rationalize demand for the medications most commonly used by older people. WHO will soon launch its Third Global Patient Safety Challenge which will focus on medication safety, in particular for elderly patients.
Gender issues
Strategies to foster womens health often target issues concerning reproduction yet women face particular health challenges in older age as well. To address the needs of women beyond the years of reproduction, WHO is developing an initiative on a life-course approach to the health of women.
Addressing the needs of older people in emergency situations
Recent emergencies and disasters have demonstrated that, while older people are one of the most significant vulnerable population groups, their needs are often poorly addressed. WHO will work with partners such as HelpAge International to ensure the needs of older people are better addressed in community risk assessments, vulnerability reduction measures, risk communications, response planning and operations and recovery. WHOs work with partners on mental health, safer health facilities, non-communicable diseases and disability related to disasters will also contribute to knowledge and action to improve health outcomes for older people in emergencies and disasters.
Source: WHO
