The World Report on Ageing and Health

Abstract

Today, for the first time in history, most people can expect to live into their 60s and beyond ( United Nations Department of Economic and Social Affairs [UNDESA], 2007 ). And those who reach 60 years of age can expect to live longer than ever before. When combined with marked falls in fertility rates, these increases in life expectancy are leading to the rapid ageing of populations around the world. These changes are dramatic, and they have profound implications for each of us as individuals, as well as for society more broadly. Longer lives present many opportunities, and the article by Fried (2016) in this supplement makes a strong case that appropriate social investment can create a “third demographic dividend” for society. Yet, the extent of the opportunities that arise from increased longevity will depend heavily on one key factor: health. If people are experiencing these extra years of life with good physical and mental capacity, and if they live in enabling environments, their ability to do the things they value may have few limits. If these added years are instead dominated by declines in capacity and disabling environments, the implications for older people and for society are much more negative. Staudinger, Finkelstein, Calvo, and Sivaramakrishnan (2016) take up this issue and look specifically at the effects of work on health in later life. Unfortunately, there is only limited information to suggest that older people today are experiencing these extra years in better health than previous generations ( Chatterji, Byles, Cutler, Seeman, & Verdes, 2015 ). Moreover, in many places, neither the policies nor the infrastructure is in place to ensure that the opportunities that arise from population aging can be realized. Public health action on ageing is therefore urgently needed. Yet debate on what this might comprise has been remarkably limited ( Lloyd-Sherlock et al., 2012 ) To progress action in this area, the World Health Organization (WHO) recently released the first World report on ageing and health ( WHO, 2015 ). Nearly 200 people contributed directly to the report, including authors of a series of background articles, many of which have been refined for academic publication in this supplement. Given the great diversity of issues that are relevant to ageing and health, it is not surprising that the scope of these articles is broad. The report outlines a public health framework for action on Healthy Ageing that is built around the concept of functional ability. This is defined by the report as “the health related attributes that enable people to be and to do what they have reason to value”. The report emphasizes that this ability is determined by both the intrinsic capacity of the individual and the influence of the environments they inhabit. This builds on capabilities-based approaches used in other fields ( Anand, 2005 ). The report approaches the changes associated with ageing in the context of the entire life course, yet focuses on the second half of life. It describes some of the important underlying physiologic changes that can occur with age (for example, those outlined in the article by Blume-Peytavi et al. (2016) on skin) but also considers the disorders that become more frequent in older age and that can impact on functioning. These are largely chronic conditions, particularly noncommunicable diseases, hearing loss, and musculoskeletal disorders as discussed by Davis and colleagues (2016) and Briggs and colleagues (2016) , respectively. Many of these can be prevented or delayed by engaging in healthy behaviors across the life course, and the benefits of these behaviors continue into later life ( Hrobonova, Breeze, & Fletcher, 2011 ). The article by Bauman, Merom, Bull, Buchner, and Singh (2016) highlights the importance of these ongoing influences, making a robust case for promoting physical activity among older adults. However, Bauman and colleagues also show how ageing influences the relationship of these behaviors to health and the importance of considering this when developing interventions to foster capacity and ability. Their article highlights how, for physical activity, this may lead to a shift in focus that gives priority to interventions that can help the retention of muscle mass and balance. Subtle shifts in messaging across the life course may also be required if these interventions are to succeed ( Notthoff & Carstensen, 2014 ). Yet, even with effective health promotion strategies, many older people will still experience chronic disease and most likely more than one of them at the same time. Integrated person-centered care can ensure these are effectively managed, particularly if they are detected early enough. And even for people where these result in significant declines in capacity, access to medical and assistive technologies (see article by Garçon et al. (2016) ) and supportive environments can ensure that they can continue to live lives of dignity and continued perso