Healthy and Positive Ageing Initiative ddsca Healthy and Positive Ageing Initiative CHaRMS Workshop 2017 Dr Sarah Gibney, HaPAI, Department of Health, ROI. 19/06/2017

Overview Policy background ddsca Overview Policy background National positive ageing indicator framework Development 2015-16 Key indicator domains Key examples Local indicators project Research and engagement 2

ddsca Policy background 3

Planning for an older population ddsca Planning for an older population International developments emphasise: Ageing as an opportunity for economic, social and cultural development; Affirmative concepts of ageing, such as healthy and active; and Strengthening research and data collection for smart, sustainable growth. WHO Active Ageing Policy (2002) underpins the Irish National Positive Ageing Strategy: Road-map for multi-sectoral policies; Incorporates a life-course perspective; and Focus on wider factors, and social determinants of active ageing. 4

WHO framework Source: WHO world report on ageing and health (2015) ddsca WHO framework Source: WHO world report on ageing and health (2015) 5

WHO framework Agree on metrics, measures and analytical approaches; ddsca WHO framework Agree on metrics, measures and analytical approaches; Improve understanding of the health status and needs of older populations; and Increase understanding of ageing trajectories and what can be done to improve them. Source: WHO world report on ageing and health (2015) 6

ddsca Positive ageing “ … an individual, community, public and private sector approach to ageing that aims to maintain and improve the physical, emotional and mental wellbeing of older people … ... the wellbeing of older people is affected by many different factors including socio-economic status, family and broader social interactions, employment, housing and transport. Social attitudes and perceptions of ageing can also strongly influence the wellbeing of older people … ” Source: National Positive Ageing Strategy (2013) 7 7

National Positive Ageing Strategy ddsca National Positive Ageing Strategy Published by the Department of Health (2013): Goal 1: Remove barriers to participation and provide more opportunities for the continued involvement of people as they age in all aspects of cultural, economic and social life in their communities Goal 2: Support people as they age to maintain, improve or manage their physical and mental health and wellbeing Goal 3: Enable people to age with confidence, security and dignity in their own homes for as long as possible Goal 4: Support and use research about people as they age to better inform policy responses to population ageing in Ireland Cross-cutting objectives: combating ageism and improving information provision 8

ddsca NPAS Goal 4 Objective 4.1 Continue to employ an evidence-informed approach to decision-making at all levels of planning. Objective 4.2 Promote the development of a comprehensive framework for gathering data in relation to all aspects of ageing and older people to underpin evidence-informed policy making. 9

ddsca National Indicators 10

Definition and purpose ddsca Definition and purpose A statistical indicator is a succinct measure (e.g. percentage) that describes a specified population, time, or place in as few points as possible Indicators are expected to simplify and facilitate communication by reducing ambiguity Indicators serve multiple functions for policy: Communication and awareness raising; Early warning; Political advocacy; Monitoring and evaluation of performance; Control and accountability; and Improve quality of decisions 11

Consensus approach “Delphi technique” to agree a set of indicators ddsca Consensus approach “Delphi technique” to agree a set of indicators Group-based technique to build and measure reliable consensus of opinion among experts on a complex issue Key features: Series of intensive surveys; Structured communication of results and feedback between survey rounds; Anonymous; Iterative; and Measure responses using statistical techniques 12

Consensus approach (continued) Delphi technique widely used in health and social policy Mental health care service planning (the Netherlands); Social service planning to prevent old-age dependency (Italy); Maternal and infant health indicators (France, Canada, Belgium, Switzerland, and the Lebanon); National wellbeing (UK); and DG-Sanco BRIDGE Health (Bridging Information and Data Generation for Evidence-based Health Policy and Research) (EU) Participants do not meet face-to-face but engage with one another at a distance through controlled feedback Encouraged to express and react to ideas free of pressure from other panellists No one respondent or group can dominate the process e.g. focus groups or forums 13

Expert panel selection Delphi process Expert panel selection Exploration Evaluation Re-evaluation Final Consensus Identify expert and stakeholder groups Invited experts to participate and/or nominate other experts from: Submission to NPAS; Publications and academic research on one or more NPAS pillars; Organisations, advisory panels and local authorities related to ageing; and Networks of older people (Age-friendly Ireland Councils and Alliances) 14

Screening long list of indicators using screening tool (n=127) Delphi process Expert panel selection Exploration Evaluation Re-evaluation Final Consensus Screening long list of indicators using screening tool (n=127) Standards Application Standard 1: The indicator is needed and useful All indicators Standard 2: The indicator has technical merit Standard 3: It is feasible to collect and analyse data for this indicator Standard 4: The indicator set is coherent and balanced overall Indicator set 15 15 15

Expert panel selection ddsca Delphi process Expert panel selection Exploration Evaluation Re-evaluation Final Consensus Online Survey Importance of each indicator to positive ageing in Ireland Each indicator is needed and useful to national stakeholders Ease of understanding each indicator Balance and coherence (of each separate domain) Rank indicators within each domain Open-ended feedback on each domain Scoping exercise of indicators for at-risk populations 16 16

ddsca Delphi process 17 17

The Irish Longitudinal Study on Ageing (TILDA) ddsca Positive ageing indicator data 2016 Programme foe the international assessment of adult competencies (PIAAC) European Quality of Life Survey (EQLS) Census of the population The Irish Longitudinal Study on Ageing (TILDA) Quarterly National Household Survey (QNHS) European Labour Force Survey (EU-LFS) European Survey of Income and Living Conditions (EU-SILC) HSE Elder Abuse Services HSE National Screening Service 18

Positive ageing indicator framework 2016 ddsca Positive ageing indicator framework 2016 Participation Health Security Employment and retirement Physical health Positive mental health Financial security Education and lifelong learning Brain health Health care Housing Active citizenship and volunteering Adaptation to disability and illness Social care Age-friendly public spaces Social and cultural participation Health behaviours Palliative care Personal safety 15 indicators 27 indicators 11 indicators Carers’ health Transport Attitudes to ageing (n=2) 19 Information access (n=1)

Positive ageing indicator framework 2016 Participation in informal education and training Participation Employment and retirement Education and lifelong learning Active citizenship and volunteering Social and cultural participation TILDA – 9 of 15 indicators % who provide care for children and/or grandchildren % who provide care to an older adult relative or disabled relative % who engage in one of more social leisure activities Self-reported loneliness (UCLA) % with at least one supportive relative or friend % who drive % who rate public transport as good or excellent Transport % who rate private transport as good or excellent 20

Key points – participation ddsca Key points – participation Employment rate age 55-64 is similar to EU-28 and increasing 63% (Q1, 2016) 5% increase (2014-2016) Volunteering rate is the 3rd highest in Europe Austria, Sweden and Ireland 1 in 4 do unpaid volunteer work for organisations weekly 1 in 3 care for children and grand children weekly High levels of social engagement and support 85% take part in social leisure activities at least weekly 9 in 10 have at least one supportive relative or friend Driving continues to be the main form of transport for the over 50s High rates of driving including above aged 75+ Public transport ratings consistently lower in rural areas (less than 25% good or excellent ) 21

Positive ageing indicator framework 2016 Health Physical health Positive mental health Brain health Health care Adaptation to disability and illness Social care Health behaviours Palliative care Self-rated health TILDA – 16 of 27 indicators Cognitive impairment Chronic disease Depression (CES-D) Walking speed Life satisfaction Chronic pain Carers’ health Sense of control & autonomy (QoL) Body Mass Index Flu vaccination % smokers Unmet need for community care Alcohol use Physical activity (IPAQ) Home care 22

Key points – healthy ageing ddsca Key points – healthy ageing Adults are living longer and in better physical health Life expectancy at 65 is above EU-28 average increased by almost 2 years 2004-2014 Healthy life expectancy at 65 increased 2010-2014 1 in 3 (32%) people aged 50+ show evidence of mild cognitive impairment Smoking rates have lowered, but problematic alcohol consumption has increased Smoking rates 17%, down 5% from 13% among 65-74 year olds, particularly among women Uptake of flu vaccination and screening services is high and has increased Most are satisfied with life 82% agree or strongly agree with the statement “I am satisfied with my life” 23 23

Positive ageing indicator framework 2016 Security Financial security Housing Age-friendly public spaces Personal safety TILDA – 3 of 11 indicators Housing condition problems Overall number of indicators == 28 of 57 indicators % of all indicators ==49% of toal Neighbourhood social capital Safety at night 24

Key points – security Consistent poverty among the over 65s is low ddsca Key points – security Consistent poverty among the over 65s is low 1 in 4 say that a lack of money prevents them from doing the things they want to do At-risk of poverty, and material deprivation is lower in Ireland than in the EU-28 and both have reduced between 2004-2014 Just over 1 in 10 of those aged 50+ have housing facility problems These include a lack of bath/shower, lack of inside toilet, lack a place to sit outside, and a shortage of space Neighbourhood social capital is high among those aged 50+ and increases with age 66% report high levels of trust in other people, safety, sense of belonging, sense of fairness, and cleanliness in their neighbourhood 25 25 25

Local Indicators Project Age-friendly Cities and Counties Survey ddsca Local Indicators Project Age-friendly Cities and Counties Survey 26

Age-friendly Cities and Counties Programme in Ireland ddsca Age-friendly Cities and Counties Programme in Ireland Local collaboration Local consultation Joined up, real change A place where leaders and decision makers from the local authorities, health and social services, Gardaí, transport, service providers, NGOs, business and academics can . . . forge an alliance, consult extensively with service providers and older adults in an Older People's Council, make a plan and – implement real change in imaginative and cost-effective ways to …. support people to stay at home, better public spaces and parks, transport that meets needs, safer places, more opportunities to participate, better health services and new opportunities to volunteer to make neighbourhoods better places for all. 27 27

AFCC infrastructure in Ireland ddsca AFCC infrastructure in Ireland ALLIANCE BOARD 3rd Level Institute Local Authority Gardai (Police) Health Service Executive Older People’s Forum Provider Business HaPAI Survey 2016 AGE FRIENDLY COUNTY STRATEGY 28 28

HaPAI survey overview Fieldwork 2015-16, response rate 56% ddsca HaPAI survey overview Fieldwork 2015-16, response rate 56% 21 Local Authority areas N=10,500 (~500 per area) age 55+ Data linkages Census Social Deprivation Index Crime statistics Spatial data e.g. location of services Mayo Cavan Louth Meath GALWAY City and Co Fingal Dublin city South Dublin Dun Laoghaire Rathdown Kildare Laois Clare Wicklow Kilkenny Limerick City & Co Tipperary Wexford CORK City & County 29 29

Analysis and reporting (2016-17) ddsca Analysis and reporting (2016-17) Ecological model of ageing Ageing is a complex blending of physiological, behavioural, social, and environmental changes at the individual and community level How are age-associated patterns of healthy and positive ageing affected by spatial, gender, ethnicity, and socio-economic status? 30

HaPAI research and engagement 2016-17 ddsca HaPAI research and engagement 2016-17 National positive ageing indicators HaPAI preliminary report (May 2015) Positive ageing indicators 2016 (online) Screening tool and methodology (online) Local positive ageing indicators 21 Local Authority reports (2016-2017) Thematic reports (2017) Stakeholder engagement National Positive Ageing Stakeholder Forum (April 2017) Local age-friendly alliances (strategy development 2016-2017) Monitoring UN monitoring guidelines on Madrid International Plan of Action on Ageing (2005, 2010, 2015) 31

HaPAI research call 2017 is open! Theme: health inequalities in ageing ddsca Contact HaPAI sarah_gibney@health.gov.ie Twitter @HaPAI_Ireland www.hapai.ie HaPAI research call 2017 is open! Theme: health inequalities in ageing Deadlines: Compulsory EOI - 28th June 12 noon Application - 6th September 32