Active Ageing and Quality of Life in Old Age 01 · Functional Health Increase in the Second Half of...

Active Ageing and Quality of Life in Old Age

Clemens Tesch-RoemerGerman Centre of Gerontology

Presentation at the Meeting of the UNECE Working Group on AgeingGeneva, 21.-22. November 2011

Related Processes

– UNECE Working Group on Ageing: „Quality of Life and Active Ageing“

– WHO: Strategy and Action Plan for Healthy Ageing in Europe, 2012-2016

Strategic priority areas for action: Healthy ageing over the life course, supportive environments, health & LTC systems fit for ageing populations, strengthening the statistical evidence base and research

Priority interventions: Falls prevention, promoting physical activity, vaccination of older people and infectious disease prevention in health care settings, public support to informal care giving with a focus on home care, including self-care, geriatric and gerontologic capacity building among the health and social care workforce

Supporting interventions: Prevention of social isolation and social exclusion, quality of care strategies for older people including dementia care and palliative care for long-term care patients, prevention of elder maltreatment

– European Year of „Active Ageing and Intergenerational Solidarity“

Structure of the Presentation

1. The Argument

2. Early investments in active ageing3. Late investments in active ageing4. Investments in societal frameworks for active ageing

5. Some precautions6. Policy recommendations7. Questions

1. The Argument

– Use a broad definition of active ageingActive ageing embraces both individual processes and societal opportunity structures for health, participation and security. Goal: enhancing quality of life as people age.

– Start earlyActive ageing begins with investments early in life (e.g. education, health behaviour, volunteering in childhood and adolescence).

– It’s never too lateEven in middle and late adulthood investments in active ageing are effective (e.g. health behaviour change, volunteering).

– Improve societal frameworksHealth, integration, and participation in late life (level, diversity and association with other variables) can be fostered by good societal frameworks (e.g. strength of welfare state).

– Don’t forget frail eldersLate in life a substantial proportion of the “old old” will need support because of multi-morbidity and frailty.

2. Early Investment in Active Ageing Idealized Effects

Potential effects of early investmentsin active ageing

High early investment (e.g. extended education)

20 80 10040 60

Low early investment (e.g. brief education)

Hea

lth/In

tegr

atio

n/Pa

rtic

ipat

ion

Age

Note: The figures shows hypothetical effects of early investments in active ageing.

2. Early Investment in Active AgeingOverview of Results

– HealthLower socioeconomic status (education, income, occupational prestige) is related to worse health. Age as leveler or age as double jeopardy? Educational differences onset of diseaseincome/wealth differences maintenance of functional health.

– Social IntegrationLow educational status: More often no confidant, no partner and lack of social support. But: No education differences in kin support.

– ParticipationHigh educational status: Higher probability of gainful employment during the last decade before retirement, higher probability of volunteering in late life.

Germany: The Effects of Educational Status in Functional Health Increase in the Second Half of Life

40

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40-54 Jahre 55-69 Jahre 70-85 Jahre

94 92

82

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74

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62

Niedrige BildungMit t lere BildungHohe Bildung

Wurm, Schöllgen & Tesch-Römer 2010: German Ageing Survey (DEAS)

Low Education: Persons without vocational training

Medium Education: Persons without vocational training or persons with highschool degree

High Education: Persons with university diploma or higher academic degree

40-54 Years 55-69 Years 70-85 Years

Func

tiona

l Hea

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)

Effects of Educational Status Are Also Clearly Seen in the Frequency of Physical Activities

0

20

40

60

80

100

Pro

zent

Seltener/nie Einmalwöchentlich

Mehrmalswöchentlich

37

22

4254

1828

74

11 15

Niedrige BildungMittlere BildungHohe Bildung

Wurm, Schöllgen & Tesch-Römer 2010: German Ageing Survey (DEAS)

rarely/never once a week several times a week

Low EducationMedium EducationHigh EducationPe

rcen

t

3. Late Investments in Active AgeingIdealized Effects

Potential effects of late investmentsin active ageing

Low late investment (e.g. no health

behaviour intervention)

High late investment (e.g. health behaviour intervention)

20 80 10040 60

Note: The figures shows hypothetical effects of late investments in active ageing.

Hea

lth/In

tegr

atio

n/Pa

rtic

ipat

ion

Age

3. Late Investments in Active AgeingOverview of Results

– HealthPhysical activity positively affects health outcomes, cognitive capacity and subjective well-being – up to very old age (80+ years).

– Social IntegrationInterventions against loneliness in very old people rely on the provision of opportunities to meet other people, training for social skills and social cognitive intervention.

– Participation“Employability” of older workers can be improved by employers (e.g. further training, job rotation) and employees (e.g. investing in skills and health). Volunteering can be stimulated by offering choice of voluntary activities, the ability to plan one’s own time table and compensation for the activity.

Effects of Physical Activity on Health in Old Age I

– Intervention study: N ~700 very old participants (mean age 87 years)

– Strength training over 10 weeks for muscles at hips and knees

– Supplement: protein-containing dietary supplement

– Control group: Placebo

Source: S. G. Leveille, A. Z. LaCroix, G. E. Moore, and M. A. Fiatarone (1994). Exercise Training for Very Elderly People. The New England Journal of Medicine, Volume, 331(18), 1237-1238.

Muscle Strength

Seite 12

Effects of Physical Activity on Health in Old Age II

Seite 12

Physical Activity– Intervention study: N ~700

very old participants (mean age 87 years)

– Strength training over 10 weeks for muscles at hips and knees

– Supplement: protein-containing dietary supplement

– Control group: Placebo

Source: S. G. Leveille, A. Z. LaCroix, G. E. Moore, and M. A. Fiatarone (1994). Exercise Training for Very Elderly People. The New England Journal of Medicine, Volume, 331(18), 1237-1238.

4. Societal Frameworks For Active AgeingIdealized Effects

Potential double effect of invest-ments in societalframeworks for active ageing (level and diversity)

20 80 10040 60

Hea

lth/In

tegr

atio

n/Pa

rtic

ipat

ion

Age

Low investmentin societal frameworks (e.g. weak welfare state)

High investment in societal frameworks (e.g. strong welfare state)

Differen

ce in

Leve

l

Differen

ce in

Dive

rsity

Note: The figures shows hypothetical effects of societal frameworks for active ageing.

4. Societal Frameworks For Active AgeingOverview of Results

– HealthSocietal wealth related to good health in old age. In poorer countries stronger age-related decline in health satisfaction and rise in self-reported disability.

– Social IntegrationCultural norms and societal wealth influence the relationship between social integration and well-being (e.g. effects of social integration may collapse when societal wealth is low and welfare state is weak).

– ParticipationEmployment rates of older workers (55-64 years) high in Northern Europe, the British Isles, and North America, lower in Central, Southern and Eastern Europe. – Volunteering rates high in Northern Europe and relatively low in Mediterranean countries.

Healthy Life Expectancy in Europe: Large Differences between Countries...

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SouthernEuropeanCountries

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http:// ec.europa-eu/health/indicators/index_en.htmData from 2009

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...but Frailty in Old Age Belongs to Life Everywhere

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5. Some Precautions I

Disability ThresholdIndi

vidu

al C

apac

ity

Age Death

Rate ofAgeing

Prototypical Life Coursewith Frailty Phase

Disability ThresholdIndi

vidu

al C

apac

ity

Age Death

Rate ofAgeing

Compression of Morbidity:- extension of life span- slowed rate of ageing- no frailty phase

Intervention

Effects:

Optimistic

Expectations

Indi

vidu

al C

apac

ity

Age Death

Disability Threshold

Rate ofAgeing

„Shifting“ of Morbidity:- extension of life span- unchanged rate of ageing- frailty phase

Intervention Effects:

RealisticExpectations?

?

5. Some Precautions II

– Exclusion of frail elders?An individualized focus on “successful ageing” could lead to the social exclusion of frail older people.

– Inclusive policiesPolicies for activating older people are necessary, but they should be complemented by policies on supporting frail and dependent older people to ensure their social inclusion and human dignity.

6. Policy Recommendations

– Setting the framework for active ageingInvesting in educationProviding securityEncouraging inclusive images of ageing

– Fostering healthy biographiesPromoting a healthy lifestyleProviding effective services of health care and long-term care

– Supporting social integrationStrengthening diverse family types, extending social ties beyond familyGiving aid to caring families

– Encouraging societal participationReinforcing employability and stimulating employersCreating opportunities for volunteering

7. Questions I

(1) How are responsibilities for active ageing shared between the individual and the society? Do individuals have a duty to make use of the opportunities provided for by the society?

(2) What should be done to avoid disadvantage to (older) people who cannot (or do not want to) invest in active ageing?

(3) Investing into active ageing: What should be done to promotelife-long learning?

(4) Investing into active and healthy ageing: What should be done to change health behaviour throughout the life-course?

(5) What should be done to change working conditions settings for improved health of older persons?

7. Questions II

(6) What should be done to stimulate active ageing in different sub-groups (e.g. people with low education, people with low income, migrants)?

(7) What difference can new images of ageing make? How can images of ageing be changed?

(8) Bearing in mind that many ageing people – notably a high proportion of the very old – suffer from illness, chronic diseases, and frailty: What could be an inclusive understanding of active ageing?

(9) The proportion of ageing people without children is rising. If residential care homes are not a preferred option for such persons: What could be an equivalent to family care?

(10) What should be done to help older people with functional limitations to live independently at home?

Active Ageing and Quality of Life in Old Age 01 · Functional Health Increase in the Second Half of...

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