The OECD Health Project Long-term Care for Older People

OECD Forum 12222 Session: Towards a New Societal Contract?
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Contents:

  • You are here
  • Informal care challenges
  • Finding new long-term care systems
  • Health policies and data
  • Long-term care spending set to double or triple by 2050 - OECD

    • The Irish HaPAI indicators [ 16 ] were developed in order to monitor and evaluate progress of the Irish National Positive Ageing Strategy [ 22 ], which had been published by the Department of Health in after a structured consensus process that included a public call for written submissions, a series of public regional consultation meetings and meetings with groups representing vulnerable and marginalized older people. The New Zealand Positive Ageing Indicators [ 17 ] were based on the principles and goals of the New Zealand Positive Ageing Strategy, which had been released by the Ministry of Social Development in after an extensive consultation process that included focus groups with a broad range of stakeholders [ 21 ].

    However, the indicators have not been presented as a tool to evaluate the future progress of the Positive Ageing Strategy.

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    Published on 16 Jan Quality in Primary Care , ; 17 1 : 75— Organization for Economic Cooperation and Development France. Health at a Glance: Europe Canadian Institute for Health Information. The distribution of indicators among domains and concepts is displayed in Fig.

    For this purpose, a two-tier monitoring system based on short annual reports and less frequently published comprehensive reports had been suggested instead [ 21 ]. The majority of the indicators presented in the online tool originated from the Public Health Outcomes Framework for England, which was developed in a broad public consultation process and has subsequently been updated on a constant basis [ 23 ].

    The indicators presented in the Public Health Outcomes Framework for Wales were tailored to the health targets outlined in the framework and were meant to assess future progress in improving population health. Publication of the Public Health Outcomes Framework for Wales followed an extensive consultation process in which approximately 60 organizations from the voluntary sector, health boards, housing associations, pharmacies, local government, as well as members of the public, took part [ 19 ].

    In addition, the development of indicators was informed by an extensive literature review on key areas that impact positive ageing and that had been outlined in the National Positive Ageing Strategy. The subsequent consensus process included an adapted Delphi technique that invited members from research and academic networks, networks of older people, local authorities and government departments [ 16 ]. The Finnish THL key indicators [ 20 ] were developed in a consensus process initiated and coordinated by the National Institute for Health and Welfare THL that included a web-based survey and consultations with multiple stakeholders, such as representatives of ministries, local authorities, universities, research institutes, statistical offices and social insurances between and The ten monitoring systems included in this review contained indicators.

    The distribution of indicators among domains and concepts is displayed in Fig. We further clustered the indicators into 47 different concepts within the 14 domains. Health areas, domains and concepts covered by the indicators in the monitoring systems included. Nursing and community care: adequate assistance, caregiver stress, comprehensive clinical assessments. Physical environment: outdoor air quality. Social environment: social support; local area social capital; trust in institutions; trust in others; community inclusion.

    Social participation: caring for relatives and children; participation in cultural and arts activities. Activities of daily living: deterioration of work ability; internet use; time spent doing selected activities.

    Mental health: severe mental strain; sense of control; positive perceptions of own age; suicides. Cognitive functioning: literacy skill; numeracy skills; mild cognitive impairment. Current indicator-based monitoring activities for health in older age proved to be very heterogeneous with regard to their structure, development and content. Some indicator sets focused exclusively on health and wellbeing in older age, whereas others referred to the whole population but defined a subset of indicators for health in older age.

    Not only did the number of indicators vary greatly between the monitoring systems, so too did the format used to present the indicators. Formats ranged from periodically published reports or brochures to websites or complex online tools offering a variety of functions. The majority of monitoring systems displayed the indicators not only on a national level but also on one or more regional levels, for example, for regions, districts or local authorities [ 11 , 13 , 15 , 17 , 18 , 20 ] and thus addressed policy makers and health care planners both on the national level and in municipalities.

    Various methods of data visualization were used.

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    We would like to specifically highlight the area profiles that were offered in some of the monitoring systems [ 13 , 15 , 20 ] and the geographical display of indicators using maps that was available in some of the indicator systems [ 11 , 13 , 18 ]. The area profiles offered detailed information for any selected region with spine charts comparing values for a region with the national average. A geographical display of selected indicators using maps allowed a quick comparison of regions. In the English example [ 13 ], a traffic-light system comparing regional values against the benchmark was available as were continuous, quartile-based or quintile-based colour schemes displaying the values on regional levels.

    The amount of metadata that was provided for the indicators varied significantly. Data sources used for the indicators were made available in all the monitoring systems included in the review. The majority of monitoring systems offered a detailed definition of the indicators and a short rationale for the indicators. Some monitoring systems also included interpretation guidance, information on data restrictions or advice for local authorities on how to act on specific issues.

    We also analysed how the indicator sets were developed and whether they were based on a national public health framework or healthy ageing strategy. We found that four out of ten indicator sets were entirely or in parts tied to a national strategy [ 13 , 16 , 17 , 19 ]. However, only two of these four indicator sets were developed explicitly in order to monitor the progress of the underlying strategy, whilst this was not the case for the two other sets. Two of the indicator sets were developed in extensive and long-dated public consensus processes [ 16 , 20 ].

    These processes included consultations with a broad range of stakeholders, such as government departments, municipalities, research institutes, academic networks, networks of older people, statistical offices, social insurances, health boards, housing associations and members of the public. Methods used to receive feedback and to form a consensus on the indicators included a public call for written submissions, a Delphi technique, a web-based survey, focus groups and bilateral as well as multilateral consultation meetings. However, in addition to these, a wide range of other concepts were covered by the indicators, which shows that the underlying definition of wellbeing and health in older age was rather broad and holistic.

    It was beyond the scope of this review to compare indicator sets between countries in more detail, i. Future research efforts will be needed to examine the options to harmonize concepts, indicators and instruments between countries in order to permit international comparisons. To our knowledge, indicator-based national monitoring systems that focus on health and wellbeing of older populations have not previously been reviewed in detail.

    As we could expect a large number of theoretical frameworks and health concepts to be covered, we chose to conduct a scoping review. A strength of this approach is that we were able to summarize and analyse a broad range of different publication types and to provide an extensive overview of national monitoring systems on health in older age. We performed a systematic search including both a structured database search and an extensive search on the websites of relevant organisations in this field.

    Informal care challenges

    However, this review also has some limitations. One of the main limitations of our review was the restriction to documents that were available in English or German language.

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    Websites or documents providing information on national health indicators mainly address professionals in health and social care and policy makers both on the national and regional levels, not an international scientific community. Seven out of the ten indicator sets included in the analyses originated from English-speaking countries, which is a highly selective choice of indicator sets. We can assume that more OECD countries provide relevant indicator sets that are exclusively published in the respective national languages.

    Finding new long-term care systems

    Secondly, additionally contacting public health authorities in OECD countries might have revealed additional information and might have guided the interpretation of information already available to us. We had considered this additional step at the beginning of our study, but decided against it, because the scoping review aimed at identifying, describing and summarizing indicators that are used for health reporting and are openly available and visible to the public. As a third limitation, we restricted our search to monitoring systems that either focused on health and wellbeing in older age or that specified a subset of indicators as relevant for health in older age.

    We thus excluded public health monitoring systems that referred to the whole population without defining subsets of indicators for specific age groups. Although the present study was not apt to provide an exhaustive review of international monitoring approaches in old age, its results helped to inform the development of an indicator-based public health monitoring of the older population in Germany.

    The indicators identified and described here were examined for duplicates and presented to an expert panel for selection of indicators in a multistage structured consensus process. Eventually, a total of 18 indicators from three health areas environmental factors, activities and participation, and personal factors were selected as being most relevant to establishing health monitoring for older people in Germany [ 7 ].

    Our scoping review illustrated that indicator-based national public health monitoring activities of older adults are highly diverse in the OECD member countries included in the analysis. Some indicator sets have been developed based on existing national strategies and in elaborate consultation processes, whereas others have not or simply do not provide details on their development process.

    In addition, there is much variety regarding the health concepts and constructs covered as well as in the way health information is presented and indicators are displayed. While this may in part reflect country-specific differences in health care systems and health needs, further research is needed to explore the opportunities and limitations of international standards. For future international efforts to implement or improve monitoring systems on health in older age we highly recommend to consider the broad range of possible approaches that have been outlined in our review before deciding on a strategy which fits the particular context, needs and expectations.

    This includes decisions on main concepts and key indicators as well as the stakeholders involved and the formats chosen for timely and effective dissemination of results. Most importantly, specific approaches will always be guided by national health priorities and health goals as well as available data and resources. England, Scotland, Wales and Northern Ireland were included as separate entities, since they have independent public health systems. Federal Statistical Office of Germany. Germany's population by Results of the 13th coordinated population projection.

    The World report on ageing and health: a policy framework for healthy ageing. The first wave of the German health interview and examination survey for adults DEGS1 : Sample design, response, weighting and representativeness. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz.

    Int J Epidemiol. Schanze J-L. Report on sampling practices for the institutionalized population in social surveys. Deliverable 2. Accessed 17 July J Health Monitor.

    World Health Organization. Accessed 22 June Developing a framework for a public health monitoring of the population aged 65 years and older: Results of the IMOA workshop on concepts and indicators. Arksey H, O'Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. Schweizerisches Gesundheitsobservatorium. Alter und Langzeitpflege. Gesundheit im Alter. Accessed 5 Feb Older Americans. Key Indicators of Well-Being. Public Health England. Accessed 1 Dec Ministry of Health New Zealand.

    The Scottish Public Health Observatory. Online Profiles.

    Health policies and data

    The Healthy and Positive Ageing Initiative. Department of Health: Positive Ageing National Indicators Report. Ministry of Social Development New Zealand. Deane Simpson, an architect who teaches at the Royal Danish Academy of Arts in Copenhagen, recently spoke at an event organised by Museum of Architecture and The Building Centre in London about designing cities for an ageing population.

    Long-term care spending set to double or triple by 2050 - OECD

    In his book Young-Old: Urban Utopias of an Ageing Society , Simpson looks at communities likefor year olds who are retired and in good health with money to spend. Simpson is critical of the way this type of lifestyle cuts people off from the rest of society, with age becoming a new form of segregation. However he accepts that they reflect a desire for an active, experience-filled lifestyle. This could be replicated as a way of integrating mobility scooters and electric wheelchairs and bicycles.

    In Denmark and the Netherlands where biking culture is strong, bike lanes are increasingly being used by mobility scooters.