who approaches to age -friendly settingsepi2008.com.br/apresentacoes/conferencia 23_09... · 60+...
TRANSCRIPT
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Dr Alexandre KalacheSenior Advisor on Global AgeingNew York Academy of MedicineInternational Center for Policies on Ageing
WHO WHO
Approaches toApproaches to
AgeAge--friendly friendly
settingssettings
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Age
00-04
10-14
20-24
30-34
40-44
50-54
60-64
70-74
80+
Millions
MALEMALE FEMALEFEMALE
300 300200 100 100 200
UN Population Division, 1998 Revision
The world population is ageingThe world population is ageing
Population PyramidPopulation Pyramid in in 19951995 and and 20252025
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Population 2000 2025 2050(in billion)
Total 6.0 7.8 8.9
More developed countries 1.2 1.2 1.2
Lessdeveloped countries 4.7 6.6 7.8
60+ 0.6 1.2 2.0
More developed countries 0.2 0.3 0.3
Lessdeveloped countries 0.4 0.9 1.7
The population in developing countries The population in developing countries
is fast increasing is fast increasing –– particularly the agedparticularly the aged
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Active Active
Ageing:Ageing:
A Policy A Policy
FrameworkFramework
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"Active ageing
is the process of
optimizing opportunities for
health, participation and security
in order to enhance quality of life
as people age"
The WHO definitionThe WHO definition
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Range of functionin individuals
Age
Functional capacity
Early Life
Growth and development
Adult Life
Maintaining highest possible level of
function
Older Age
Maintaining independence and preventing disability
Rehabilitation and ensuring the quality of
life
Disability threshold
Source:Kalache and Kickbusch, 1997
A Life Course Approach to Active Ageing A Life Course Approach to Active Ageing
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Determinants of Active AgeingDeterminants of Active Ageing
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The three pillars of a policy The three pillars of a policy
framework for Active Ageingframework for Active Ageing
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Institutional
Community care
Informal care
Self care
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Institutional
Community care
Informal care
Self care
$
$
$
$
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Health and Social ServicesHealth and Social ServicesHealth and Social ServicesHealth and Social ServicesHealth and Social ServicesHealth and Social ServicesHealth and Social ServicesHealth and Social Services
Active Ageing DeterminantsActive Ageing Determinants
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The need for AgeThe need for Age--friendly friendly
Primary Health CarePrimary Health Care
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WHO main staircaseWHO main staircase
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AgeAge--friendly friendly
PHC projectPHC project
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• To enable and empower older people as they age to remain…
• Active
• Productive and
• Independent for as long as possible
• through increasing accessibility, responsiveness and comprehensiveness of community-based health care
Project Goal Project Goal
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• To minimise barriers to care
• To promote age friendly attitudes and
services
• To ensure comprehensiveness of community-
based health care services
• To increase geriatric knowledge and skills of
community-based health care staff
• To support coordination and linkages with
other community-based groups, services, and
family
Objectives for AgeObjectives for Age--friendly PHC centresfriendly PHC centres
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• Stage I: to identify a set of general age-friendly principles to make primary health care centres more age-friendly
• Stage II: to develop and pilot the Age-friendly PHC centre Toolkit to support the implementation of the "Age-friendly Principles for PHC Centres" by PHC centres
• Stage III: to compile a final toolkit for the implementation of the "WHO Age-friendly Principles for PHC Centres" in a variety of settings throughout the world
Key stagesKey stages
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Identifying age-friendly principlesIdentifying age-friendly principles
• 44 focus groups in five countries with users and providers were conducted
• Interdisciplinary expert group
• Consensus on general principles for age-friendly community-based health care
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Stage I: Age-friendly PrinciplesStage I: Age-friendly Principles
were developed and widely circulated
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General principles in three general areas
General principles in three general areas
1. Information, education and trainingAttitudes:
“Just look at the nurse’s face, you don’t want to ask questions” (older person, Jamaica)“They are miserable and difficult and set in their ways” (provider, Philippines)
Training“She listens; she treats me as an equal..we discuss things; she gives me choices…the freedom to make choices is what I want.” (older person, Canada)“Doctor sit me down and explain how dangerous it was. No doctor ever do that before. She explains that if I do not change my habits I will go to insulin.”(older person, Jamaica)
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2. Management Systems
Cost:“I had to leave some of the prescription because I didn’t have enough money, they are too dear and I still haven’t gone for them.” (older person, Jamaica)“Our services can do more for older people provided the issue of payment is tackled.”(provider, Malaysia)
Not enough time:“I was amazed at the short interviews so I started timing them, two and a half minutes…” (older person, Australia)“Lack of time would not be a barrier if there was a system that helps the general practitioner recall the elderly patient’s past records.” (provider, Malaysia)
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3. The Physical Environment
Unclean and uncomfortable facilities:“They need to put a bench with a cushion, not the old concrete thing… and open the bathroom.” (older person, Jamaica)“One of the gentlemen had a stroke and can not sit for very long…we cannot manage to lift him and we do not have a
wheelchair .” (provider, Jamaica)
Distance and transport:“I don’t go. I need somebody to take me. Children are all working.I don’t want to bother them.” (older person, Malaysia)“Transport is a big issue because if you have someone who was coughing and had incontinence, how could she catch the bus and get down to see me?” (provider, Australia)
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Developing AgeDeveloping Age--friendly PHC friendly PHC
CentresCentres
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Stage II: to develop and pilot the Age-friendly PHC centre Toolkit on
how to become an age-friendly primary health care centre
Stage II: to develop and pilot the Age-friendly PHC centre Toolkit on
how to become an age-friendly primary health care centre
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Piloting and evaluating of the "Age-friendly PHC centre Toolkit"
Piloting and evaluating of the "Age-friendly PHC centre Toolkit"
• Protocol and evaluation instruments for piloting the toolkit developed by 15 October 2006
• The field work conduced from 16 October 2006 to 30 April 2007
• Six countries participated in the pilot: Brazil, Costa Rica, Jamaica, Singapore, Spain and Turkey
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Stage III: to compile a final toolkit for the implementation of the "WHO Age-friendly Principles for PHC Centres"
Stage III: to compile a final toolkit for the implementation of the "WHO Age-friendly Principles for PHC Centres"
• Final meeting of the coordinators tookplace in Geneva from 16 to 18 July
• A final version of the toolkit wasfinalized at this project final meeting
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WHO partners:
• TSAO Foundation
• HelpAge International
• The New York Academy of Medicine
• Ministry of Health, France
• Ministry of Health, Brazil
• Red Cross International
• Health Co-op, Japan
• Oswaldo Cruz Foundation
• Social Security, Costa Rica
AF PHC Toolkit AF PHC Toolkit
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http://www.who.int/ageing/publications/upcoming_publications/en/index.html
Toolkit is available at:Toolkit is available at:
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AgeAge--friendlyfriendly
Cities projectCities project
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Sequence in each citySequence in each city
• Listening to older people's voices
• Analysis by experts
• Workshop with policy-makers
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A growing global cityA growing global city
Percent Urban Population in Major World
Regions
010
20304050
607080
90100
wor
ld
Afric
a
Asi
a
Eur
ope
Latin
Am
eric
a an
d
Car
ibbe
an
Nor
th A
mer
ica
Oce
ania
Perc
en
t
2005
2030
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More older people in cities in the developing world
More older people in cities in the developing world
• the number of persons aged 60 + in developing countries will be 9 times greater than now
• the share of older persons living in urban areas will be 16 timesgreater
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Contrasts in urban ageingContrasts in urban ageing
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What is an Age-Friendly City?What is an Age-Friendly City?
Inclusive and accessible urban
environment that promotes active
ageing
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Age-Friendly Collaborating Cities
AMERICASArgentina, La PlataBrazil, Rio de JaneiroCanada, HalifaxCanada, Portage La PrairieCanada, SaanichCanada, Sherbrooke QBCosta Rica, San JoseJamaica, KingstonJamaica, Montego BayMexico, CancunMexico, Mexico CityPuerto Rico, MayaguezPuerto Rico, PonceUSA, Portland
AFRICAKenya, Nairobi
EUROPEGermany, RuhrIreland, DundalkItaly, UdineRussia, MoscowRussia, TuymazySwitzerland, GenevaTurkey, IstanbulUK, EdinburghUK, London
EASTERN MEDITERRANEANJordan, AmmanLebanon, TripoliPakistan, Islamabad
SOUTH-EAST ASIAIndia, DelhiIndia, Udaipur
WESTERN PACIFICAustralia, MelbourneAustralia, MelvilleChina, ShanghaiJapan, HimejiJapan, TokyoBC Ministry of Health
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An Encompassing and Empowering Research Process
An Encompassing and Empowering Research Process
• Identification of structural, organizational, economic, attitudinal barriers
• "Bottom-up" process to develop criteria relevant to older persons
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Focus groups with older persons to determine
Focus groups with older persons to determine
�What aspects of the city are "age-friendly"?
�What are the barriers and problems?
� How can the city become more age-friendly?
With complementary focus groups with informal
caregivers and service providers
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Key FindingsKey Findings
No city is perfect
No city is too far behind
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Key Findings: Lived Exclusion and Inclusion
Key Findings: Lived Exclusion and Inclusion
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"There are few seating areas.. You get tired and you need to sit down" (Melville, AU)
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"Cross lights are made for Olympic runners" (Halifax, CA)
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Much information is available but
finding needed information is complicated (Moscow, Russia)
Much information is available but
finding needed information is complicated (Moscow, Russia)
"As your faculties
begin to fade, this kind of thing appears
to cause more in terms of stress"
(Halifax, Canada)
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Structures and spacesStructures and spaces
• Seating, toilets, sidewalks, structural barriers
• Clean and green
• Bus drivers and seating
• Reserved Parking
• Accessible, safe and secure
• Appropriate housing, close to services
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"We are not going out in the evenings. I don't go
anywhere… They might kill you" (Tuymazy, Russia)
"We are not going out in the evenings. I don't go
anywhere… They might kill you" (Tuymazy, Russia)
"I have my retirement salary but how can I live with this little money?" (Istanbul, Turkey)
"The doorman is really nice, he looks after 4 people in my building" (Rio de Janeiro, Brazil)
"People would notice if you weren't at mass"
(Dundalk, Ireland)
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Services, Attitudes and Behaviours
Services, Attitudes and Behaviours
• Affordable
• Close to home
• Considerate, personalized, friendly and flexible
• Reach the hard-to-reach
• Integrates ages, abilities and cultures
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The WHO Guide and Checklist The WHO Guide and Checklist
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Beyond the Release of the Guide Beyond the Release of the Guide
• Age-friendly planning and action in collaborating cities
• Dissemination to other countries and communities
• Validation of the Guide
• Age-friendly Rural and Remote Community Guide
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Beyond the Release of the Guide (2)Beyond the Release of the Guide (2)
• International age-friendly cities network
– Age-friendly city best practices inventory
– Best practice conferences (Essen 2007;
Istanbul 2008)
• International age-friendly communities research
– "Ageing in a foreign land"
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The growing presence of older persons in our increasingly
urban and globalized world…
The growing presence of older persons in our increasingly
urban and globalized world…
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Reminds us of
our common
Humanity.
We must…
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Design for
Diversity
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And Promote SolidarityAnd Promote Solidarity
Solidarity is the tenderness of peoples, Jorge Luis Borges
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Ageing and Life Course Programme (ALC)Ageing and Life Course Programme (ALC)http://www.who.int/ageing/en/http://www.who.int/ageing/en/
AgeAge--Friendly CitiesFriendly Citieshttp://www.who.int/ageing/age_friendly_cities/en/index.htmlhttp://www.who.int/ageing/age_friendly_cities/en/index.html
AgeAge--Friendly Cities materialFriendly Cities materialhttp://www.who.int/ageing/age_friendly_cities_material/en/indhttp://www.who.int/ageing/age_friendly_cities_material/en/ind
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