Elsevier

The Lancet

Volume 387, Issue 10033, 21–27 May 2016, Pages 2145-2154
The Lancet

Health Policy
The World report on ageing and health: a policy framework for healthy ageing

https://doi.org/10.1016/S0140-6736(15)00516-4Get rights and content

Summary

Although populations around the world are rapidly ageing, evidence that increasing longevity is being accompanied by an extended period of good health is scarce. A coherent and focused public health response that spans multiple sectors and stakeholders is urgently needed. To guide this global response, WHO has released the first World report on ageing and health, reviewing current knowledge and gaps and providing a public health framework for action. The report is built around a redefinition of healthy ageing that centres on the notion of functional ability: the combination of the intrinsic capacity of the individual, relevant environmental characteristics, and the interactions between the individual and these characteristics. This Health Policy highlights key findings and recommendations from the report.

Introduction

Today, for the first time in history, most people can expect to live into their 60s and beyond.1 In less developed countries, this longevity is largely the result of much reduced mortality at younger ages.2 In high-income countries, continuing increases in longevity are now mainly due to rising life expectancy among those who are 60 years or older, although these general trends might not be sustainable and mask substantial inequalities within countries.3, 4 When combined with falling fertility rates, these increases in life expectancy are leading to the rapid ageing of populations around the world.

These changes are striking and the implications are profound. A child born in Brazil or Burma (Myanmar) today can expect to live 20 years longer than one born only 50 years ago. In Iran, only around one in ten of the population is currently older than 60 years. In only 35 years' time, this proportion will have increased to around one in three. And the pace of change is much faster than was the case in the past.

Longer life is an incredibly valuable resource. It provides the opportunity to reconsider not only what older age might be, but how our whole lives might unfold.5 For example, in high-income countries, there is evidence that many people are rethinking rigid notions of what older age might consist of and are looking to spend these extra years in innovative ways, such as a new career, continuing education, or pursuing a neglected passion.6 Moreover, as young people start to expect longer lives they, too, might plan their lives differently.

Yet, the extent of the opportunities that arise from these extra years of life will be very heavily dependent on one key factor: health. If people are experiencing these years in good health, their ability to do the things that matter to them will be little different from that of a younger person. If these added years are dominated by decreases in physical or mental capacity, the implications for older people and for society are much more negative.

Although increasing longevity is often assumed to be accompanied by an extended period of good health, little evidence exists that older people today are experiencing better health than their parents did at the same age.7 While much research has been done in this area, the findings are very inconsistent and vary geographically.8, 9, 10, 11, 12, 13, 14, 15, 16 Moreover, even in high-income countries, trends within different subgroups of the population can be quite distinct.4, 17

Research reported in 2014 by WHO suggests that although severe disability in older people (that necessitates help from another person for basic activities such as eating and washing) might be decreasing slightly, no substantial change in less severe disability has been noted in the past 30 years.18

However, although 70 does not yet appear to be the new 60, there is no reason why this cannot become reality in the future. But it will need a coherent and focused response across multiple sectors and stakeholders. To date, this response has largely been lacking.19 To provide a public health framework for action, WHO has released the first World report on ageing and health.20 The report considers ageing from a life-course perspective, but focuses on the second half of life. This Health Policy paper highlights key findings and recommendations from the report. The authors were mostly members of the core writing group.

In developing the report, WHO brought together both the many departments undertaking work related to ageing and the different levels of the Organization. Report chapters were drafted by a core group of internal and external contributors. They drew on 19 commissioned background papers drafted by largely external experts that were either systematic or scoping reviews, depending on the topic. Most are currently under peer review for separate academic publication (see appendix for details).

The report included various analyses of existing datasets including WHO's Global Health Estimates,21, 22 the WHO Study on global AGEing and adult health (SAGE),23 the World Health Survey,24 the Australian Longitudinal Study on Women's Health,25 the Survey of Health, Ageing and Retirement in Europe,26 the Health and Retirement Study,27 the English Longitudinal Study of Ageing,28 and data from the World Bank. The statistical methods for the selected findings presented in this paper are shown in the appendix.

Section snippets

The epidemiology of population ageing

The increases in life expectancy observed globally during the past 50 years have been accompanied by substantial changes in cause of death. Figure 1 shows mortality patterns across the life course for countries at different stages of socioeconomic development. Although data for deaths in older age are far more robust than information about morbidity, even estimates of mortality should be interpreted with caution because high-quality data are scarce for all low-income and most middle-income

Healthy ageing

In framing a public health response to population ageing, the World report therefore considers the multitude of health characteristics we have described as well as underlying physiological changes and psychosocial changes associated with ageing as interacting to determine an older person's intrinsic capacity. This capacity is defined as the composite of all the physical and mental (including psychosocial) capacities that an individual can draw on at any point in time.

At present, most

A public health framework for healthy ageing

The report identifies many entry points for action to foster healthy ageing through the shared goal of maximising functional ability. This goal can be achieved in two ways: through the building and maintaining of intrinsic capacity, and through enabling someone with a given level of intrinsic capacity to engage in the things that matter to them. In doing this, the report emphasises the importance of considering not only approaches that ameliorate the losses associated with older age but also

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