The World Health Organisation defines an age friendly community as one that enables people of all ages to actively participate in community activities and treats everyone with respect, regardless of their age. It is a place that makes it easy for older people to stay connected to people that are important to them. And it helps people stay healthy and active even at the oldest ages and provides appropriate support to those who can no longer look after themselves.
We speak to Dr Carol Holland, psychologist with expertise in the cognitive and health psychology of ageing and Chair in Ageing at the Centre for Ageing Research, Lancaster University, on her views on promoting the idea of healthy ageing in communities.
How do we create an environment that promotes healthy ageing within our communities?
The concept of healthy ageing has various definitions, some of which are more helpful than others in terms of building resilience and ageing positively, but also in terms of reducing health care burden for national health services, health care costs for the individual, and social or personal care costs for the community. A definition that includes ageing without any health concerns whatsoever is unhelpful given that 80% of those aged 65 plus have at least one chronic illness (CPD 2009), and 50% have more than one.
However, a definition of ‘successful ageing’ that includes lifespan personal development is perhaps a more helpful approach. The resilience of people who succeed in achieving a positive balance between gains and losses during ageing, not just coping with decline, but they continue to actively develop themselves on numerous fronts, as Baltes and Baltes (1990) would have defined it.
This understands that people can age positively even in the context of increasing frailty towards the end of life, and does not negate the quality of life and experiences, or personal value of even the frailest. An environment that values and supports the aims and goals of older adults, ranging from active healthy older adults to the less mobile or frail, is a healthy ageing environment. Infrastructures that provide the support for accessible mobility, pleasant, safe places to walk and understanding and care for people who may be experiencing losses or impairments not only promote healthy ageing, but also value the personal assets, skills and experience of all members of their community, including the retired. Such an environment naturally addresses the risk factors for some common ageing related diseases, such as providing space to be physically active or intellectually engaged, and reducing the risk of social isolation and loneliness.
An environment that values and supports the aims and goals of older adults, ranging from active healthy older adults to the less mobile or frail, is a healthy ageing environment.
What are some of the areas that constitute the concepts of healthy ageing that is beneficial for long term care setting?
Long term care has a number of opportunities to improve the lives of residents who may have been struggling to cope in their original homes. The areas that can be addressed begin with nutrition and support for eating a healthy balanced diet. Many older adults are at risk of undernourishment especially if they need assistance, time and patience to prepare or eat their meals, or may simply not have bothered to cook because they were living alone. Addressing deficiencies, for example in the amount of protein consumed, or important vitamins, can have very significant impacts both on physical frailty and also cognitive function. Combined with this are improving opportunities for physical activity.
Probably the most robust evidence from the scientific community on prevention of dementia, improvement of symptoms of dementia within those diagnosed, and improvement of cognitive function even in healthy older adults is the impact of physical activity, with the adage that ‘if it’s good for your heart, then it’s good for you brain’, being a useful concept.
However, what a care environment can provide that older people living independently may have felt the lack of, is company. We know, for example, that mobility impairments are strongly associated with depression, particularly in older age, related to isolation. However, our own evidence from an evaluation of residents moving into a large retirement village is that this relationship reduces once people have settled into an environment that is both physically and socially accessible. Someone who is disabled and isolated by their difficulties with steps and stairs is no longer disabled if there are no steps in their home or to where they want to go. While our research had many reports of people who felt they had lost the loneliness on moving into the retirement village, some even going so far as to say they felt it was the start of a new life for them, we are aware that others did not find it easy to make new friends and engage socially with new people.
How can countries adapt the ideology of healthy ageing communities with lessons from the UK?
Changing our communities to be more age friendly is a priority worldwide. There is increasing evidence that older people are more at risk of isolation in urban environments due to factors varying from the fear of crime in a neighbourhood, the physical accessibility of their home, to the traffic and distance between their home and places to buy healthy food or pleasant places to meet their friends. Current programmes aimed at addressing social isolation in UK cities, supported by the “Ageing Better” foundation, address a variety of issues such as age friendly cities, intergenerational co-operation, but perhaps most importantly, programmes that enable older adults to have roles and use their skills, hobbies and experience to benefit their communities. Programmes where older adults are listened to and their roles valued has impact not only for their own quality of life and self-efficacy, but also for the wider community.
However, each aspects of ageing cannot be considered in isolation. Changing concepts of inevitability of decline to one of an understanding of the possibilities and priorities of prevention or rehabilitation in health care issues, needs to be considered alongside integration of care provision and services, and changing concepts of environmental design.