The increase in life expectancy and the decrease in birth rates are causing the average age of the population worldwide and the proportion of the older population to become increasingly greater. The life expectancy of Spaniards is among the highest in Europe and there is one person over 65 years of age for every four of working age.
This increase in longevity is not always accompanied by quality of life and good health. With aging, physical and mental abilities are gradually lost and the risk of suffering from diseases increases. In fact, dependency rates are also increasing year after year. For this reason, population aging generates an unprecedented challenge for health systems in all countries.
Healthy aging is often understood as a positive disease-free state where healthy and sick individuals can be distinguished. But understanding it this way is usually problematic at advanced ages, since most older people have one or more diseases, but they can have them under control and have little influence on their daily lives.
For this reason, the World Health Organization changed the paradigm and defined healthy aging as the process of promoting and maintaining over the years the functional capacity that allows well-being in old age.
Functional capacity is defined as “the health-related attributes that enable a person to be and do what is important to them.” It is composed of the person's intrinsic ability (the combination of his or her physical and mental abilities), his or her environment (including the physical, social, and political environment), and the interactions between the person and the environment.
The optimal aging process is one that maintains high intrinsic capacity over the years. However, if throughout this process the person suffers a decline in their intrinsic capacity, a favorable environment can compensate for these deficiencies and maintain functional capacity.
However, certain people may suffer such decline that, even in a favorable environment, they are unable to undertake the basic tasks of daily living on their own. Then they require another person, which is called care dependency.
This care can occur in the home itself, perhaps with some adaptation, or by relocating to a more prepared environment. 80% of seniors prefer to live in their home or community, probably because they feel a sense of connection, security and familiarity. However, aging in place may not be the best option for those who are isolated, those who live in an unfavorable environment or with too many levels of care. It is in these cases when the option of entering a residence becomes necessary.
Although we are facing a rapid transition towards population aging, health systems are not keeping pace and are not prepared to meet healthy aging goals. The main objective of the conventional care system has been to manage or cure people's illnesses. This system has worked relatively well: it has allowed the life expectancy of the population to increase, but it has caused the population to live longer with less health and quality of life.
Prolonging health over the years and reducing the gap between life expectancy and healthy years of life must become the new objective of health systems. To do this, it is necessary to enhance people's functional capacity. In fact, focusing on promoting the intrinsic capacity of older people is more effective than prioritizing the management of specific chronic diseases. It can even help avoid unnecessary treatments, polypharmacy and its side effects.
Likewise, conventional residential care has been based on a medical model of service delivery that operates more like a hospital than a home. Probably because geriatric residents are an extremely complex and vulnerable population, with high levels of physical dependence, cognitive impairment, multimorbidity, and polypharmacy. Thus, care has focused primarily on keeping older people alive and meeting their basic needs, such as bathing or dressing, at the expense of the goals of healthy aging.
However, we know that the functional capacity of residents declines very quickly and that dependency on care could be the most important financial expense of these institutions. Likewise, residences should be redefined towards a more positive and proactive role, where care seeks to optimize people's intrinsic capacity and offer a favorable environment to compensate for possible lack of capacity.
To meet these needs of an aging population, significant changes are required in our health policies. It is necessary to apply prevention, education and health promotion strategies at the level of the entire population, not only for the elderly. Healthy aging encompasses the entire life cycle.
One of the keys to promoting long-term health is promoting healthy lifestyles. This includes encouraging regular physical activity, a balanced diet, reducing toxic habits such as smoking or alcohol consumption, and even non-physical factors, such as stress management, sleep, optimism, laughing, learning, being socially connected or have a purpose in life.
Consequently, patients must move from being passive recipients of healthcare to becoming active participants in their health and care planning. To do this, they must be well educated about lifestyle optimization, have sufficient medical knowledge and take control over their health goals.
This article was originally published on The Conversation
Pau Moreno Martin, physiotherapist and professor at the University of Vic – Central University of Catalonia. Eduard Minobes Molina is director of the Department of Basic Health Sciences, and associate professor of Physiotherapy at the same university. Javier Jerez-Roig is a professor at the same center and Head of the Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O).
