October 12, 2015

The How of WHO--the Time is Now

The best part of the WHO report, “World Report on Ageing and Health,” is the stories. After reading a long litany of the weaknesses of the long term care system (or non-system) all over the world, it’s inspiring to learn of a model that actually works.  And what’s particularly noteworthy is that some of the programs instituted in the developing world have something to teach us in the US. 

The WHO report speaks somewhat scornfully about the high tech approaches to caregiving that are the talk of the town in the west—robotic caretakers and remote monitors that are likely to be too expensive for widespread use. Instead, it touts an interactive, web-based support tool for caregivers of people with dementia. It can be accessed via computer, tablet or, what is most useful in the developing world, smart phone. The educational portal offers eight lessons for caregivers, complete with homework, and provides a coach to grade the homework. 

Another surprise: Turkey has developed a system of integrated health and social care (the only truly integrated forms of senior care in the US are nursing homes and PACE, a small program providing medical and social services to older individuals who have Medicare and Medicaid and are nursing home eligible). In the Turkish system, which is free to families and is funded through taxes, municipal budgets, and premiums paid by workers and employers, the Ministry of Health provides health care at home, delivered by a multidisciplinary team. The ministry of Family and Social Policies offers social support in multiple sectors. And municipalities provide services such as home health aides and home repairs.

Creating an “age-friendly” world sounds daunting since it involves revamping transportation and urban planning (traditionally government functions) as well as redesigning jobs (typically a private sector endeavor) and preventing elder abuse, physical, mental, and financial. The Intergenerational Clubs in Viet Nam are reportedly very successful and represent a step in the right direction. A City for Seniors in Geneva serves as the ultimate senior center, providing opportunities to socialize, to take training courses, to participate in seminars and debates, and to access information. Norway has adopted “universal design,” going beyond ramps and elevators for those with disabilities to maximize accessibility and usability for older people. And there are a few programs in the US that made it into the WHO report, examples of initiatives that are worth promoting such as Experience Corps, which places volunteers in elementary schools to stimulate reading.

WHO’s "next steps" form an ambitious program. The report identifies four priority areas: aligning the health system with the needs of the older population (shifting the emphasis from acute to chronic diseases and from individual doctors and nurses to interdisciplinary teams); developing a long term care system (involving both home care and institutional care); creating an age-friendly environment (re-making much of the societal infrastructure); and improving the way we measure success (to facilitate monitoring and understanding).  

A number of countries have taken the first steps in the right direction: Age Well is a community-based peer-to-peer support program in Cape Town, South Africa. Older individuals are trained to provide companionship and social support for others in their community, and to identify needs and make referrals to the relevant health care or social service agencies. The program reports 60% improvement in measures of well-being among participants. Live and Age Together (Vivre et Vieillir Ensemble) is an ambitious undertaking in Quebec that brings together local and national government, the private sector, and families to develop a comprehensive approach to support older adults.

We can do all that WHO advocates. We can do it for the right reasons—because it would improve the well-being of a large and growing segment of the population; or for the wrong reasons—because it would, on balance, be less expensive to do it than not to. But that’s the beauty of the WHO proposal: it should appeal to the left and the right, the rich and the poor, the young and the old, in all countries, whatever their politics.

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