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

2. Overview Policy background
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Overview
Policy background
National positive ageing indicator framework Development
Key indicator domains
Key examples
Local indicators project
Research and engagement 2

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Policy background 3

4. Planning for an older population
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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

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

6. WHO framework Agree on metrics, measures and analytical approaches;
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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

7. 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

8. National Positive Ageing Strategy
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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

9. 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

10. ddsca
National Indicators 10

11. Definition and purpose
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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

12. Consensus approach “Delphi technique” to agree a set of indicators
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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

13. 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

14. 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

15. 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

16. Expert panel selection
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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

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Delphi process 17 17

18. The Irish Longitudinal Study on Ageing (TILDA)
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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

19. Positive ageing indicator framework 2016
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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)

20. 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

21. Key points – participation
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Key points – participation
Employment rate age is similar to EU-28 and increasing
63% (Q1, 2016)
5% increase ( )
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

22. 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

23. Key points – healthy ageing
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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
Healthy life expectancy at 65 increased
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 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

24. 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

25. Key points – security Consistent poverty among the over 65s is low
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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
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

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

27. Age-friendly Cities and Counties Programme in Ireland
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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

28. AFCC infrastructure in Ireland
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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

29. HaPAI survey overview Fieldwork 2015-16, response rate 56%
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HaPAI survey overview
Fieldwork
, 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

30. Analysis and reporting (2016-17)
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Analysis and reporting ( )
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

31. HaPAI research and engagement 2016-17
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HaPAI research and engagement
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 ( )
Thematic reports (2017)
Stakeholder engagement
National Positive Ageing Stakeholder Forum (April 2017)
Local age-friendly alliances (strategy development )
Monitoring
UN monitoring guidelines on Madrid International Plan of Action on Ageing (2005, 2010, 2015) 31

32. HaPAI research call 2017 is open! Theme: health inequalities in ageing
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Contact HaPAI
HaPAI research call 2017 is open!
Theme: health inequalities in ageing
Deadlines:
Compulsory EOI - 28th June 12 noon
Application - 6th September 32