How to live longer and better. Positive ageing
//Políticas europeas en materia de envejecimiento
Demographic forecasts indicate that by 2060 the average age of the population in the European Union will stand at 47.6 (around 15 years higher than in the previous century). The percentage of people over 65 years old will also increase: from 9% in 1960, to an expected 27% in 2050. Likewise, the proportion of the “oldest old” is rising, and will reach 15% of the expected population of countries such as Spain and Germany forty years from now.
Clearly, Europeans are living longer and longer, but are they living better?
In fact, ageing and chronic health conditions go hand in hand: 49% of European women and 39% of men over 50 years old have at least two chronic diseases simultaneously. Chronic diseases affect patients’ quality of life and also have an impact on the health system, as chronic patient care requires a considerable investment in human and financial resources. Public spending is expected to increase by 4.1 percentage points of GDP in the EU by 2060, and much of this increase will be to pay for pensions, long-term treatments and healthcare.
The rate of old-age dependency will almost double and, consequently, the active population will shrink. “Currently, four Europeans work to maintain one who has already retired; in the future two people will work for each retired person. To prevent this situation we need to act in advance, and this involves changing the social model. The traditional model in which young people work and old people are at home will vanish. Life expectancy will be long, but with health complications. At the moment, 20% of our lives are spent with health problems. The idea is to try to reduce this percentage and to live longer, but to live better”.
The statement above was made by María Iglesia-Gómez, head of the Innovation for Health Unit of the European Commission’s Directorate-General for Health and Consumers. She leads a team that works specifically on drawing up strategies to assimilate the impact of population ageing and ensure the health system’s sustainability. To achieve this, the European authorities have set a first objective for 2020 that is highly specific and ambitious: to increase healthy life expectancy – that is, the number of years that people live independently – by two years. The main way to meet this objective is by promoting active and healthy ageing at all levels.
Active and healthy ageing
According to the World Health Organization’s (WHO) definition, healthy and active ageing is the process of optimizing opportunities for health, participation and security to enhance the quality of life as people age. This principle applies both to individuals and to population groups. “Healthy” refers to physical, mental and social well-being. “Active” refers to continuing participation in social, economic, cultural, spiritual and civic affairs, not just to the capacity to be physically active or work.
Optimum ageing means maintaining the power to make decisions about your life for as long as possible, and living your daily life without the help of others (or with as little assistance as possible). To achieve this, it is essential for individuals to adopt healthy habits in relation to diet, exercise, posture, cognitive stimulation, stress prevention, emotional regulation and control of anxiety, social participation, culture and leisure as factors of development, and the correct use of medication. The adaptation of social and healthcare services and the use of new technologies could also contribute to increasing the autonomy of elderly people, delaying dependency and, if a person does become dependent, providing tools that facilitate self-advocacy.
European policies on ageing
“We realised that this couldn’t be a regulatory or legislative process. It had to be a collaborative process, and we decided to work with all of the agents involved: health professionals, companies in the sector, carers, universities, research centres, public authorities and, of course, elderly people. This led to the emergence of the Healthy Ageing Innovation Partnership”. María Iglesia-Gómez refers to the over three thousand entities that are already working in action groups on the six priorities identified by her team, with assistance from 33 experts in the fields of innovation and ageing.
“The priorities that we have established are: an increase in patients’ treatment adherence; early diagnosis and prevention of falls, which is currently one of the main reasons for hospital admissions; prevention of functional decline and fragility in elderly people; comprehensive care that involves combining health and social care services; interoperability of the standards that exist in European Union countries; and finally the design of environments that favour active and healthy ageing, with the formation of a network of age-friendly cities”.
The European Commission proposes a framework of actions, but it is the local agents that will implement them. “This is an innovative, bottom-up experience, in which we have a completely secondary role: we focus on identifying the main needs and verifying whether the projects that are underway work or not. We draw up a series of indicators to measure the efficacy of actions that our partners are carrying out; because participation is voluntary but all those involved agree to submit the results and to be assessed”. The parameters used to determine how far we are from ensuring the health system’s sustainability are specific data such as savings in hospital beds or the reduction in polypharmacy spending resulting from one initiative or another.
The idea is to transfer initiatives of demonstrated use to other environments. Therefore, the exchange of information, experience and resources between groups is fostered, interregional connections are promoted, and a network of centres of excellence has been created in which active ageing policies are already being implemented successfully. “We created a ranking to show that this model does indeed work. Each area had to present its best practices based on criteria of innovation and population impact, with quantifiable results that can be extrapolated. Thus, we identified 32 areas of excellence and 71 good practices”.
Leading areas include Scotland, which already has definitive results, Denmark, Southern Italy and Catalonia. “However, these cases should be extended throughout the continent. And this involves a change in model. For example, we have found that care for elderly people is more important than treatment. Systems that provide rational, personalized care at home are cheaper and more efficient for patients. So we consider that the system should be people-centred and services should be redesigned in accordance with their needs”.
We must learn about concepts such as comprehensive, multidisciplinary, personalised care; daily living aided by the environment; literacy in health; patient empowerment; and electronic or mobile health. These are the areas that public health has to move into to survive. We have to seek practices that are sustainable for the system and friendly for patients, and many of the projects underway in Europe have already achieved this. Furthermore, the flow of actions has generated political awareness of the need to intervene.
“We are talking about a European agenda for active ageing that goes beyond the voluntary participation of our members. Member States are working towards this, with decisions such as the incorporation of ‘Health, Demographic Change and Wellbeing’ as one of the social challenges to meet in the Horizon 2020 programme; the launch of Joint Actions on ageing and some age-associated diseases; and finally the creation of a Knowledge and Innovation Community (KIC) on active and healthy ageing. However, we stress again, population ageing requires a series of mid- to long-term measures that are essential if we wish to maintain the system”. Clearly, this must be accompanied by a change in people’s habits. Because the idea is to live longer, but also to live better.