Ageing in the Twenty-First Century: - HelpAge International

Chapter 2: A fresh look at evidence – Advancing health into old age
Nationwide caravan to train
one million dementia supporters
In 2005, the Japanese Ministry of Health, Labour and
Welfare, together with organizations concerned with
dementia, launched a 10-year nationwide public
campaign, the Campaign to Understand Dementia and
Build Community Networks. Central to the campaign is
the nationwide caravan to train one million dementia
supporters. The objective of this programme is to train,
in the next five years, one million “dementia supporters”
who understand the disability and provide support to
persons with dementia and their families.
Source: International Longevity Center Japan,
http://longevity.ilcjapan.org/f_issues/0603.html
The main areas of action are: increase awareness and
understanding of dementia; strengthen health and
social systems and services to tackle the growing burden;
enhance support and services for dementia caregivers
and their families; and increase the priority given to
dementia in the public health research agenda.
The aims and objectives of the approach should either be
articulated in a stand-alone dementia policy or plan or
be integrated into existing health, mental health or
old-age policies and plans. Some developed countries
have launched policies, plans, strategies or frameworks
to respond to the impact of dementia. However, by
2012 only eight countries worldwide had national
programmes in place to address dementia. Some
countries have regional or sub-national-level plans
or programmes.
Injuries and other issues
Injuries, particularly those caused by falls, in older
persons are an often unrecorded but frequent event
which may start a downward spiral in health status,
resulting in death or long-term care needs.
Approximately 28 to 35 per cent of people over the age
of 65 fall each year and injure themselves, increasing
to 32 to 42 per cent of those aged more than 70 years.
Falls may lead to post-fall syndrome, which includes
increased dependence, loss of autonomy, confusion,
immobilization and depression. Within the year
following a hip fracture from a fall, 20 per cent of older
people will die. 134
Yet falls may be prevented through a number of
interventions, including clinical interventions to
identify risk factors, improving safety in the home,
exercises to improve balance and community-based
group education and exercise programmes.
Mental health and well-being are core health issues at
all ages. While depression is identified as a significant
cause of disability and a likely problem in older age,
social isolation and loneliness are generally not recorded
in population surveys. Changing living arrangements
may be exacerbating these issues. For example, in some
European countries, more than 40 per cent of women
aged 65 or older live by themselves. Facilitating social
participation of people in older age groups can not only
benefit society, but also help avoid or overcome the
loneliness experienced by many people in later life. 135
Poor oral health is common in older people worldwide.
Tooth decay and lack of dental care, severe gum disease,
tooth loss, ill-fitting dentures, dry mouth, oral cancer,
and oral pain and discomfort are conditions that impair
quality of life. But again, older people are under-served
because of the high cost of care, and poor availability
and accessibility of oral health services.
Palliative care
Many of the common causes of death in older age may be
associated with pain and distress. Yet in many countries,
access to effective pain relief is extremely limited and
millions lack access to any form of palliative care.
Palliative care is defined as “an approach that improves
the quality of life of patients and their families facing
the problem associated with life-threatening illness,
through the prevention and relief of suffering by means
of early identification and impeccable assessment and
treatment of pain and other problems, physical,
psychological and spiritual…”. 136
A mapping exercise undertaken in 2011 found that 136 of
the 234 countries assessed have one or more hospicepalliative
care services established. 137 Comparing the
development of palliative care between 2006 and 2011
shows that the most significant gains have been made in
Africa. The limited access to palliative care is reflected
in the use of opioid analgesia per person (the use of
pain relievers that act on the central nervous system).
In many countries, access to opioids is severely limited,
even for treatment of severe pain at the end of life.
People living in the poorest countries tend to have much
less access than those in developed nations. 138
Training in palliative care
The Hospice Palliative Care Association of South Africa
is offering training courses for professional and nonprofessional
health-care workers in a number of centres
throughout the country. Courses include home-based
care, bereavement support care, palliative nursing care,
psychosocial palliative care and training of trainers.
Source: The Hospice Palliative Care Association of South Africa, www.hpca.co.za/
training_courses.html
64 Ageing in the Twenty-First Century: A Celebration and A Challenge