WHO Calls for Major Shift in View Toward Older People

Miriam E. Tucker

October 01, 2015

A new report from the World Health Organization (WHO) calls for a dramatic shift in the way governments, societies, and health systems think about and approach a rapidly growing older population.

Timed to coincide with the WHO International Day of Older Persons on October 1, the organization's World Report on Ageing and Health was released September 30, 2015, at a briefing held at the United Nations Foundation headquarters.

By 2050, the number of people who will be older than 60 years is set to double. "Today, for the first time in history, most people can expect to live into their 60s and beyond. The consequences for health, health systems, for the work force, and for the budgets of countries are profound," WHO Director-General Margaret Chan, MD, said at the briefing.

The new report, she said, "summarizes the opportunities that accompany population aging, and also the many barriers and knowledge gaps that block these opportunities. It is in our collective interest to work together to unblock these barriers."

Among the current impediments are a one-size-fits-all approach to older people despite their great diversity and the notion that older age always implies dependence and increased cost. "There's a lot of misconception [that] chronological age is linked to functional disability. That's not the case," Dr Chan said.

John Beard, MD, director of the WHO's Department of Ageing and Life Course and a lead author of the report, told Medscape Medical News that one of the report's implications for healthcare professionals is "to step beyond the idea that healthy aging is the absence of disease and to realize that what's more important for an older person is their functional ability that comprises both themselves and the environment they live in."

Older people should be viewed holistically, Dr Beard said. "Try and do some form of assessment as to how they're functioning and how all their different problems and challenges add up, and use that as a guide to [future action]," he advised, adding, "Unfortunately, systems at the moment often tend to react to seeing older people as a bucket of individual diseases and respond to each disease as the presentation arises. I think the first thing we need to do is to move beyond that, to think in a holistic way."

Think "Investment" Rather Than "Cost"

The 245-page report defines "healthy aging" as "the process of developing and maintaining the functional ability that enables well-being in older age."

To achieve that goal, detailed recommendations are provided for four "priority areas for action": Aligning health systems to the populations they now serve, developing improved systems of long-term care, creating age-friendly environments, and improving measurement and monitoring to ensure that the changes are having the intended beneficial effect.

The overall tone of the report is positive, asking that expenditures on older populations be viewed as "investments" rather than "costs." It notes that population aging may not be that expensive, as has been assumed, in part because aging per se has been shown to contribute far less to overall healthcare expenditures than have changes in healthcare-related technologies.

And in fact, the report says that in some high-income countries, healthcare expenditures per person fall significantly after the age of 75, whereas expenditures for long-term care rise.

Dr Beard said that increases in healthcare costs with age tend to be higher in the United States than in some other countries, such as the Netherlands, Japan, Korea, and Germany, where there are comprehensive systems for long-term care.

"I hope this report gets people to realize that older populations are a fantastic opportunity.... The shift from just seeing older populations as a burden on society I hope will be one major step. And then, looking to how we can across the life course do things to ensure that the well-being and the contribution of older people are maintained for as long as possible."

He added, "That might cost a little bit ― I don't think it will be nearly as costly as people think ― but it's a good investment. And when you make a good investment, you get a return, in terms of the well-being of older people, their contribution to society, and social cohesion."

Both Dr Chan and Dr Beard are employees of the WHO. They have disclosed no relevant financial relationships.


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