10,11 The clinician has a key role in ameliorating age-related and pathological changes. 9 While old age is not usually devoid of ill health, age-related impairment, limitation and restrictions that contribute to frailty can be modified. In developed countries, such as Australia, ischaemic heart disease, visual disorders, dementia, cancers and stroke are common contributors to disease burden (Table 1). It is the sum of years of life lost due to premature death and those lost to disability. The ‘disease burden’ can be measured in disability-adjusted life years (DALYs), where a DALY reflects one year of ‘healthy’ life lost. Functional status is a major independent risk factor for dependency, institutionalisation and mortality in older populations. Themes Physical and functional healthĪgeing well is influenced by fixed (genetic) and modifiable factors.
The challenge of working in a cultural environment that does not necessarily value older people will be considered. The use of an enablement approach in promoting functional status and mental health will be presented. The aim of this article is to provide an overview of ways clinicians can work with older patients to optimise their health and wellbeing during the later years of life.
General practitioners (GPs) work with older people (aged ≥65 years) across the spectrum: the 7.8% living in residential care, 2.4% on home and community care packages (Australian Institute of Health and Welfare 2014 figures) 8 and the remaining majority who are living independently in the community. Older Australians are a heterogeneous group, not least in terms of their degree of independence. 7 The framework’s focus is not decline rather, it highlights functional and social activity and participation. In this regard, the ‘International classification of functioning, disability and health’ (ICF) provides a useful framework for considering the interrelationships between the person and their environment. The promotion of healthy ageing focuses on sociocultural and physical factors. To fulfil these aspirations, people need to maintain adequate physical and mental health status. 3,6Ĭommon to these theories and statements are the concepts of independence, autonomy, purposeful and meaningful existence, and the opportunity to participate and contribute. 5 Organisations such as the World Health Organization (WHO) have also issued resources advocating for optimal health in older people. 3Ī range of theories seek to explain the later stages of ageing, such as Rowe and Kahn’s successful ageing 4 and Baltes’s selection, optimisation and compensation theory. 1,2 Healthy ageing is defined as ‘the process of developing and maintaining functional ability that enables wellbeing in older age’. Healthy ageing and its associated concepts (eg successful ageing, positive ageing, ageing well, ageing productively) have been developed over the years as a response to changing population demographics.
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