Aidastra's Vision: Aligning with WHO to Redefine Healthy Ageing Through Functional Ability

1. A New Paradigm: From Decline to Functional Ability

Fundamental Shift: The report advocates a fundamental shift in perspective on ageing. The goal is not merely the absence of disease but the development and maintenance of functional ability that enables well-being in older age.

Key Concepts:

Healthy Ageing: The process of developing and maintaining the functional ability that enables well-being in older age.

Functional Ability: Comprises a person's intrinsic capacity (their physical and mental capacities), the environments they inhabit, and the interaction between them. It determines whether a person can be and do what they have reason to value.

Intrinsic Capacity: The composite of all an individual's physical and mental capacities. It declines gradually over the life course but is not solely determined by chronological age.

Environments: Include the physical, social, and policy contexts that influence functional ability.

Supportive environments can compensate for losses in intrinsic capacity.

2. Heterogeneity and Equity: Ageing is Not Uniform

Great Diversity: There is no typical older person. Capabilities and health needs are highly diverse, shaped by cumulative advantages and disadvantages across the life course.

Addressing Inequity: Health in older age is profoundly influenced by factors like gender, ethnicity, education, and wealth. A central goal of public policy must be to reduce these avoidable and unfair health inequities.

3. Health Trajectories: Focus on Capacity, Not Just Disease

Dynamic Process: Health in older age is best understood through trajectories of intrinsic capacity and functional ability, which are dynamic and can be influenced.

Three Common Periods:

High and Stable Capacity: Focus on prevention, risk reduction, and early detection/management of chronic diseases.

Declining Capacity: Focus on comprehensive assessment, interventions to slow, stop, or reverse decline (e.g., physical activity, nutrition), and managing multimorbidity.

Significant Loss of Capacity: Focus on providing long-term care that maintains dignity, provides rehabilitation, and includes palliative care when needed. The goal is to optimize functional ability despite significant intrinsic capacity loss.

4. Health Systems Must Be Transformed

Person-Centered and Integrated Care: Current health systems, often designed for acute care, are poorly aligned with the needs of older populations. They must be reoriented towards:

Person-Centered Care: Care that is coordinated around an individual's needs, preferences, and values.

Integrated Care: Seamless care across settings (e.g., hospital, home, community) and providers, and integration between health and social care systems.

Key Reforms:

Comprehensive Assessments: Use assessments that focus on intrinsic capacity and functional ability, not just disease diagnosis.

Care Planning: Develop individualized care plans in partnership with the older person.

Support for Self-Management: Empower older people to manage their own health conditions effectively.

Workforce Training: Equip all health professionals with competencies in geriatric care, person-centered approaches, and interdisciplinary teamwork.

5. The Central Role of Long-Term Care Systems

Definition: Long-term care is the activities undertaken by others to ensure that people with significant loss of intrinsic capacity can maintain functional ability consistent with their basic rights and human dignity.

Goal: To support ageing in place where possible and desired, providing a range of services fromhome-based care to residential facilities, all focused on maintaining autonomy and quality of life.

6. The Critical Importance of the Environment

Creating Enabling Environments: Policies in urban planning, transport, housing, and social protection are crucial for Healthy Ageing. Age-friendly environments remove barriers and support participation and mobility, directly impacting functional ability.

Conclusion: A Call for Societal Action

The report concludes that achieving Healthy Ageing requires a profound societal shift—away from ageist stereotypes and towards recognizing the diversity and potential of older people. It demands a collaborative, multi-sectoral response where health systems provide person-centered, integrated care, and broader policies create inclusive, supportive environments that enable all people to live a long and healthy life.