Dr Jane M Barratt, Global Advisor at the International Federation on Ageing (IFA), spoke to Lorna Rothery about healthy population ageing, the benefits this demographic shift can bring and the need for countries to work together to combat ageism and nurture age-friendly environments
The IFA is a non-governmental organization based in Canada. Its goal is to be a global point of connection and a network for experts who can influence and shape age-related policy. Approaches to improving the lives and wellbeing of older adults vary at the international, national, and regional levels. In Canada, for instance, provinces and territories fund long-term care services through general tax revenue; the amount of subsidies people can receive and the availability of services vary by province and territory.
The COVID-19 pandemic highlighted long-standing systemic challenges impacting the provision of care for seniors and the need for more robust efforts to support physical and mental wellbeing across the lifespan. In Canada, the Minister of Health and the Minister of Seniors were mandated to develop national long-term care standards and a Safe Long-Term Care Act to improve the quality, safety, equity, and availability of long-term care. In May this year, Canada’s Minister for Seniors, Seamus O’Regan Jr., also announced an investment of $71.27mn in 3,451 community-based projects supporting seniors across the country.
Lorna Rothery spoke to the IFA’s global advisor, Dr Jane Barratt, about the importance of integrated, inclusive and comprehensive long-term care and why the agenda for promoting healthy population ageing at all levels must be founded on strong, unified efforts.
What opportunities are associated with population ageing?
The world is ageing rapidly, with some countries experiencing this more quickly than others. In the Northern Hemisphere, many countries have grown rich before their populations aged, which has had significant economic implications. In contrast, many countries in the Global South haven’t had the same economic advantages.
When we consider population ageing, it’s part of demographic changes that are closely linked to globalization, migration, and urbanization. In Canada, we see significant migration due to favorable immigration policies, especially for people from the Global South. As a result, we have a diverse ageing population. It’s important to recognize that older people are also generally healthy and stay in the workforce longer. This has led to changes in retirement age and social security policies. As people live longer, they are contributing to the economy and society in various ways, such as through volunteering and supporting their families. As life expectancy increases, the standard of living also rises. The role of grandparents and volunteers needs to be valued and supported, considering the health economics of ageing.
There are three trajectories in the latter half of life: significant capacity, declining capacity, and significant loss of capacity. It’s important to focus on prevention to address the likelihood of chronic comorbidities as people grow older. Governments should increase their percentage of GDP focusing on prevention, as currently, it’s less than 5% across OECD countries. Some countries have national programs focused on health in older age, such as Australia’s Living Longer Living Stronger program.
How are current models of care unsuited to dealing with the challenges of population ageing?
When we talk about long-term care from the WHO perspective, we’re talking about providing services to people in their own homes rather than having them move into a nursing home. This type of care is community-based and focuses on enabling individuals to continue doing what they value as they grow older. I don’t understand why we say people are ‘ageing in place’; it’s nonsense. They grow older in an environment that allows them to do what they value, which is critically important. When we think about services being provided in someone’s home, they could have had a heart attack, so cardiac rehab is brought to their home. This support continues over time. In many countries, these services are all connected with funding that is also linked. This way, we can ensure that people don’t get lost in the system and have access to accessible community services.
This fragmented approach to care doesn’t align well with our overall goal of prevention, especially in the context of healthy ageing. This also applies to individuals with cognitive impairment. Once someone is diagnosed with cognitive impairment, society tends to devalue them and view them as less useful. This is why creating dementia- inclusive communities and promoting friendly environments is crucial.
We must recognize the diversity within the older population and develop services that allow them to live in the environment of their choice. Additionally, we often talk about rights of older adults in terms of human rights, but there is still a long way to go in ensuring these rights are fully realized.
Following the launch of the first UN Decade of Healthy Ageing progress report, what does the IFA make of this report, and how is it working to support a Decade of Healthy Ageing?
The initiative was established because Member States’ governments based it on a 2015 report from the WHO on ageing and health. The report highlighted the need to focus on the rapidly growing older population. Member States identified four key areas that need attention: long-term care, integrated care, age-friendly environments, and combatting ageism. The initiative aims to improve the quality of life for older people through global collaboration across diverse stakeholders. Enablers such as research and evaluation, multi-stakeholder engagement, leadership, and capacity are crucial to addressing these action areas.
For example, in Canada, combating ageism is challenging because there is no national plan for population ageing, only guidelines at the jurisdictional level. This makes it difficult to tackle ageism nationally without the support of federal and provincial bodies. Ageism can manifest as personal or institutional bias, affecting areas such as long-term care.
The IFA has pledged to evaluate all its portfolios through the lens of the action areas. For instance, in our work in vision health, we identified barriers to access to integrated care for people needing vision assessments and then developed care pathways to address these issues.
As we approach 2030, we have several important initiatives to consider: the Decade Report, the Immunization Agenda 2030, and the Sustainable Development Goals 2030. When we reach 2030, I am not certain if we will look back and feel satisfied with our achievements or if we will realize the enormity of the challenges ahead. Despite this uncertainty, I am optimistic due to the positive practices being implemented, such as Denmark’s strong reablement programme. However, our current structure may pose some difficulties in implementing such initiatives uniformly.
How important is international collaboration to the development of solutions that meet the needs of a diverse ageing population?
Collaboration and partnerships, both within a province and across countries internationally, are fundamental to advancing an agenda. It is essential that we come together across different sectors and disciplines to develop a shared agenda. While we may approach this from different perspectives, it is the combined knowledge, creation, exchange, and transfer that enables us to set goals. Although health systems may vary, we can still apply common principles and build upon them to achieve our objectives. Therefore, it is crucial to drive change and create opportunities. Refusing to learn from one another is not an option.
If political parties are not aligned in their values and commitment to addressing population ageing and taking a life course approach to public health, then progress will be slow. This was evident during the pandemic, especially with the unacceptable number of older people dying in facilities. While leaders say we must do better, it seems like there are competing agendas and a lack of alignment in what parties want to achieve. There needs to be a commitment to moving forward without going back and forth. I’m optimistic that leaders will realize the need to work together and that sustained investment is critical for the entire population.
