U n i v e r s a l h e a l t h c o v e r a g e a n d h e a l t h y a g e i n g are available to them; concurrent social trends; changing aspirations; and knowledge gaps. How can such a response be achieved? First, health needs to be viewed in a way that is relevant to all older people. In view of the likelihood of comorbidity and the centrality of geriatric syndromes in older age, a conceptual framework that focuses on functioning rather than disease would probably be most relevant. Public health policy for ageing could then be designed to maximise levels and trajectories of functioning in older age, and the ability of older people to do the things that are important to them regardless of their functional capacity. To optimise trajectories of functioning, health systems could be redesigned to better provide co-ordinated and informed geriatric services that enable older people, as much as possible, to age in place (for example, at home or in the community). Ideally, these services would be linked with social and long-term care to provide a continuum of care from early detection through to treatment, rehabilitation, provision of assistive devices and palliative care. Although few LMICs have established such a continuum of care, there is an opportunity for existing health services to be adapted to better meet the unique needs of older people. These adaptations might include basic geriatric training for all health staff, or practical steps such as reducing queuing time for frail older people. Diagonal approaches – an integration of vertical models that focus on a disease and horizontal models that focus on health care delivery systems – might also be considered to meet emerging needs (for example, control of hypertension) by building on existing services (such as chronic HIV care). In all settings, greater attention will need to be given to building and supporting an appropriately trained workforce, including both formal and informal carers. Relying on international health worker migration is problematic since it can simply shift shortages from 40 Commonwealth Health Partnerships 2015 more to less developed countries. Strategies to retain older health workers, and perhaps to recruit and train older people as new health workers, will therefore be important. For those entering the workforce, a greater emphasis on geriatrics in core medical training curricula, along with a rethinking of the culture of many clinical services that treat older people as generic vessels of single-organ disease, is essential. References Brooks-Wilson, A. R., 2013. ‘Genetics of healthy aging and longevity’. Human Genetics, 132, pp. 1323–1338. González-González, C., Samper-Ternent, R., Wong, R. and Palloni, A., 2014. ‘Mortality inequality among older adults in Mexico: The combined role of infectious and chronic diseases’. Panamericana de Salud Pública, 35, pp. 89–95. Gubler, T. and Pierce, L., 2014. ‘Healthy, wealthy and wise: Retirement planning predicts employee health improvements.’ Psychological Science, 25 (9), pp. 1822–1830. JOHN BEARD is director of the Ageing and Life Course Programme, World Health Organization (since 2009). A physician, he initially worked in primary health care in Australia, including several years as medical officer for an aboriginal medical service. He led the public health group responsible for developing Stay on Your Feet, one of Australia’s first and largest community-based programmes to prevent falls in older adults. He was a founding investigator for 45 and Up, an ongoing Australian longitudinal study of 250,000 older adults, and his research in New York demonstrates a clear influence of the urban environment on depression, disability and obesity in older people.
Commonwealth Health Partnerships 2015
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