Healthy Ageing a Challenge for Europe It is never too late for health promotion

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Healthy Ageing a Challenge for Europe It is
never too late for health promotion
Gunnar Ågren Director General Swedish
National Institute of Public Health
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Backgrond - a demographic challenge Population
distribution in EU 25 by age group (1950-2050)
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A demographic challenge and a possibility

• Photo NHS Health Scotland
• In 2050 there will be two persons aged 15-64
  years for each person aged 65 and older -
  compared to four at present.
• Half the population will be 50 or older
• Three times as many older than 80 two thirds of
  them females.

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Aims of the Healthy Ageing project

• To promote healthy ageing in later life stages
  (people aged 50).
• Review and analyse existing data on health and
  ageing
• Make recommendations for policy at EU and
  memberstate levels
• Disseminate the findings and facilitate the
  implementation

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Partners 9 countries represented

• European Older People's Platform (AGE)
• EuroHealthNet
• World Health Organisation (WHO)
• Austrian Health Promotion Foundation
• Middlesex University in England
• Folkhälsan an NGO for public health and
  health promotion in Finland
• Universita Degli Di Perugia in Italy
• Nationaal Instituut voor Gezondheidsbevordering
  en Ziektepreventie (NIGZ) in the Netherlands
• Norwegian Knowledge Centre for the Health
  Services
• Ministerio da Saúde, Direcao Geral da Saúde in
  Portugal
• NHS Health Scotland
• National Public Health Institute in the Czech
  Republic
• Swedish National Institute of Public Health
  (coordinator of the project)
• - and co-funded by the European Commission.

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Framework
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• Priority topics
• Retirement and pre-retirement phases
• Social capital
• Mental health
• Environment
• Nutrition
• Physical activity
• Injury prevention
• Substance use/misuse (tobacco and alcohol)
• Use of medication and associated problems
• Preventive health services

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Cross-cutting themes

• Inequality in health
• Socioeconomic determinants
• Gender
• Minorities

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Retirement and pre-retirement

• Healthy workplaces makes it possible for
  elderly people to work
• Increase the participation of older workers and
  the quality of their working lives using new
  management concepts.
• Keep a balance between personal resources and
  work demands. Do not tolerate age discrimination.
• Prevent illness in the workplace, promote healthy
  lifestyles and a supportive and stress-free
  transition from work to retirement.

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Employment rates 55-64 varies among EU Member
States
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Social capital

• Priority topics for action
• Encourage the participation of older people in
  the community.
• Increase educational and social activity group
  interventions targeting older people, to prevent
  loneliness and isolation.
• Provide opportunities for voluntary work by older
  volunteers voluntary work is healthful.

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Mental health

• Priority topics for action
• Address the wider determinants - such as social
  relationships, poverty, discrimination - that
  have an impact on mental health and well-being in
  later life.
• Raise awareness of mental health issues relevant
  to older people, such as depression and dementia.
• Increase the provision of psychotherapeutic and
  psychosocial interventions for older people.

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Environment

• Priority topics for action
• Improve access to safe and stimulating indoor and
  outdoor environments for older people. Air
  quality very important.
• Elderly people often vulnerable to extreme
  weather conditions.

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Nutrition

• Priority topics for action
• Promote healthy food and eating habits among
  older people.
• With an emphasis on low intake of saturated fats
  and high consumption of fibre-rich foods, green
  vegetables and fruits.

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Physical activity

• Priority topics for action
• Increase the level of physical activity among
  older people in order to reach the international
  recommendations of 30 minutes or more preferably
  all days of the week.
• At least in a moderate-intensity physical
  activity level.

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Physical activity

• Primary care-based interventions consisting of
  brief advice given by a health professional and
  supported by written materials are effective in
  increasing the level of physical activity.
• Interventions consisting of referral to an
  exercise specialist and targeting individuals are
  effective in increasing the level of physical
  activity.
• Interventions consisting of brief counselling
  (3-10 minutes) may be as effective as more
  lengthy counselling in increasing the level of
  physical activity.
• Good access to physical activity for all age
  groups

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Standardised mortality rates for people gt 65 by
injury cause in the WHO European region
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Injury prevention

• To reduce falls among older people there is
  evidence to suggest that (1)
• Home-hazard assessment and modification by a
  health professional may reduce the frequency of
  falls.
• A multi-factorial fall-risk assessment and
  management intervention is effective among people
  aged 60 and over.
• A higher level of leisure-time physical activity
  prevents hip fracture.
• Certain physical activity programmes may reduce
  the risk of falls.

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Injury prevention

• To reduce falls among older people there is
  evidence to suggest that (2)
• Tai Chi courses and other activities that promote
  balance and strengthen muscles, individually
  prescribed at home by trained health
  professionals, are effective.
• Community fall-prevention interventions are
  effective in reducing falls and fall-related
  injuries.
• Careful prescription or withdrawal of
  psychotropic drugs decreases the risk.
• Hip protectors help prevent hip fracture in older
  people living in institutional care and at very
  high risk of fracture.

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Substance use/misuse

• Priority topics for action
• Promote smoking cessation
• The reduction of harmful alcohol consumption
  among older people

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Substance use/misusealcohol

• Alcohol problems among older people can be
  divided into three categories
• Seniors who have used alcohol excessively
  throughout most of their lives.
• Seniors who drink at low levels but are
  inadvertently mixing alcohol with other drugs in
  ways that are harmful.
• People who begin to use alcohol excessively for
  the first time when they get older.

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Use of medication and associated problems

• Priority topics for action
• Problems associated with the use of medication
  can be avoided by the systematic use of quality
  indicators for drug use and better co-ordination
  among care providers.
• Surveys of therapies and the inclusion of older
  people in clinical trials will also help.

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Relationship between age and use of medicines
reflected in number of prescription items per
inhabitant in Sweden
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Preventive health services

• Priority topics for action
• Make preventive health services, such as
  vaccinations accessible to older people, paying
  special attention to frail older people,
• Consider preventive home visits under certain
  conditions.
• Take health literacy into account when working
  with older people.

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Preventive health services

• There is evidence to suggest that
• Vaccination against influenza is effective in
  reducing hospitalization for heart disease,
  cerebrovascular disease, pneumonia and influenza.
  It also reduces the risk of death.
• Homecare interventions for older people,
  extending beyond home visits, are effective in
  reducing the number of days spent in hospital
  re-admissions.
• Home visits can have modest effects in reducing
  mortality.
• Home visits are effective in reducing admission
  to long-term institutional care/nursing homes for
  older people.

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National Policies/strategies

• The Healthy Ageing project has compiled 23
  policies from 22 countries.
• Twelve countries have policies specifically on
  healthy ageing but few include special allocation
  of funds for health promotion.
• Majority are multi-annual policies endorsed by
  Health Departments.
• Aims vary from increasing life expectancy,
  improving quality of life to maintaining
  autonomy.
• Little information about implementation.

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Policies/strategies examples

• Hungary Improving the health of the elderly
• Aim Give Hungarian citizens opportunity to live
  as healthily as possible
• Lithuania National strategy for the impact of
  ageing on the population
• Aim Social integration
• The Netherlands Policy for older persons in the
  perspective of an ageing population
• Aim Stimulate participation
• Portugal National plan for the health of the
  elderly
• Aim Active ageing promote active life and
  autonomy of the elderly

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Good practice

• The Healthy Ageing project has compiled 16
  projects.
• Social capital and physical activity are the most
  common topics, often in combination.
• Challenge is to attract population who is harder
  to reach and involve and support motivation.
• Gender perspective demands special attention.
• Collaboration at several levels needed for
  effective health promotion.

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Recommendations Policy

• The European Commission and the Member States
• Develop sustainable policies, health programs and
  financial frameworks at all levels.
• Integrate the significance of health and health
  promotion for older people in all policy areas.
• Develop indicators for healthy ageing.
• The Member States
• Develop action plans, with participation of older
  people.
• Strengthen health promotion in basic and
  continuing education in gerontology and
  geriatrics.

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Recommendations Research

• The European Commission and the Member States
• Develop research to assess the effectiveness and
  the cost-effectiveness of health promotion and
  prevention.
• Strengthen research for ways of motivating and
  changing the lifestyles of older people,
  especially the hard to reach groups.
• Develop indicators of healthy ageing, and to
  include data on the very old in health-monitoring
  statistics and research.
• Disseminate research findings among all
  stakeholders.

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Recommendations Practice

• The European Commission and the Member States
• Stimulate exchange of knowledge and experience.
• Local authorities, practitioners, officials, NGOs
• Design projects and programs with the involvement
  of older people.
• Encourage a partnership approach in health
  promotion strategies.
• Rely on scientific data and evidence-based health
  promotion.
• Inform a wide range of audiences.
• Create opportunities to have regular physical
  activity, healthy eating habits, social relations
  and meaningful occupations.

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RecommendationsCore principles

• Older people are of intrinsic value to society.
• It is never too late to promote health.
• Equity in health, includes non-discrimination of
  older people.
• Autonomy and personal control is essential.
• Heterogeneity take in account differences in
  gender, culture, ethnicity, sexual orientation,
  variations in health, disability and
  socioeconomic status.

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"Ageing is like climbing a mountain. You get out
of breath but you have a magnificent view"
(Ingmar Bergman)
www.healthyageing.nu