6.2 Knowledge of the concrete

Good Older Life With Well-being And Health

Over the past many years, we Danes have achieved an ever-increasing life expectancy, and we have also gained more healthy years of life. In line with this development, it is important that we as a society focus on the quality of the extra years of life and on the differences in the elderly population’s health behaviour, health and well-being. For many, a good elderly life is associated with managing oneself for as long as possible. Most older people thrive, have good physical and mental health and feel that they can do what they want. Weakness due to illness or changed life events can, however, lead to a reduced quality of life, and a health that can set limitations for the individual in everyday life and the ability to manage oneself, maintain social relationships and participate in society.

In the rate pool agreement for 2019 in the area of the elderly, funds were set aside for a national action plan for the good life of the elderly. With the National Board of Health’s professional presentation Good elderly life with well-being and health, we are making our contribution to the Government’s work in developing an action plan for good elderly life. The professional presentation has been prepared with the broad involvement of key parties and experts in the field of health and the elderly in Denmark. The various parties and experts have participated partly through a reference group, partly through themed working groups, who have all contributed to this professional presentation with good, constructive input. I would therefore like to thank all actors who participated for the good cooperation. The professional presentation contains a number of recommendations, all of which are intended to support good elderly lives with a focus on ensuring as many elderly people as possible a healthy aging with courage and quality of life. It includes self-reliant as well as frail elderly people as well as relatives of the elderly.

The focus of all the recommendations is to support good communities, prevention and health promotion and social inclusion of the elderly. With this professional presentation, we hope that we can contribute to more elderly people living good elderly lives with health and well-being and without impairment and loneliness, from the transition from the labor market to a dignified end of life.

Healthy Aging

The average life expectancy of Danes has increased steadily in recent decades, and the elderly population is expected to grow considerably in the coming years as well.

With such demographic changes, questions arise as to whether the extra years of life have led to more good years of life among the elderly, or whether the extra years of life are, on the contrary, characterized by poor health and a limited level of functioning.

In the specialist literature, the term healthy aging is used as a general term for maintaining a relatively good state of health and a good level of functioning with increasing age.

But how healthy aging should be defined and operationalized, as well as how it is measured in the population, are questions that have been the subject of extensive international interest and research for many years.

Furthermore, there has not been a review of the literature in the area in Denmark. Previous research in the area has made it clear that healthy aging is a complex area to elucidate and monitor at population level, as there is, among other things, great variation in the elderly population in terms of age, functional level, health status and labor market attachment. This report aims to contribute to a closer understanding of what healthy aging is. The first part of the report explains how healthy aging can be defined and operationalised, which indicators are central to this work, as well as which available Danish data sources exist to shed light on healthy ageing. In the second part of the report, based on a review of the literature, the development in the health of the elderly in Denmark over the past decades is described.

Prevention And Health Promotion For The Elderly

Good health is an important prerequisite for a good life as an elderly person . Being healthy affects the ability to join communities, participate in meaningful activities and maintain autonomy for as long as possible, and these are all factors that many elderly people associate with a good elderly life 1 . The health and well-being of the elderly is not just a matter for the individual citizen and their relatives. The municipalities are responsible for creating the framework and services that can make it easier for all older people – including the frail and vulnerable group – to make healthy choices. Whether it’s going for a walk or quitting smoking. The purpose of this publication is to inspire the municipalities to work with health promotion and prevention for the elderly and to qualify , target and strengthen the efforts. The publication provides concrete recommendations for how the municipality can work with health promotion and prevention for older citizens. The recommendations are taken from the National Board of Health’s prevention packages for the municipalities. In addition, the publication contains a number of concrete examples of initiatives from municipalities that can inspire others. The target group for the publication is municipal managers and planners who are responsible for health-promoting and preventive initiatives for the elderly.

Prevention In The Area Of The Elderly

The goal of the preventive efforts in the area of the elderly is that older people can maintain their health, well-being and functional ability and thus live an independent and meaningful life for as long as possible.

Purpose The purpose of the handbook is to support the municipalities’ preventive work in the area of the elderly, so that older citizens can preserve and promote their physical, mental and social health, functional capacity and quality of life for as long as possible. And that impairment of functional capacity is limited, so that the individual’s dependence on help from others is postponed or avoided. The health, well-being and functional capacity of older citizens is a common concern for the individual, their relatives, the local community, municipalities, regions and the state. The individual citizen has responsibility for his own life and for the choices and actions that contribute to creating health and well-being. While the state sets the overall framework, the municipalities are responsible for ensuring healthy frameworks and services locally that promote health and well-being and prevent illness and reduced functional capacity. The handbook must contribute to the municipalities’ work with prevention in the area of the elderly being carried out with high professional quality and as targeted and efficient as possible. In this connection, it is essential that the preventive efforts are targeted at the elderly citizens, who are at greatest risk of reduced functional capacity, and that the efforts are thought of across the social and health fields. The handbook presents knowledge about older citizens who are at risk of functional impairment and can therefore typically benefit from preventive measures. Knowledge is also presented about efforts that can support the individual to maintain and promote health, well-being and functional ability for as long as possible. There is still great potential in preventive efforts in the population, including for older citizens. The descriptions in the handbook are based on the current best national and international knowledge and evidence as well as practical experience. In this connection, the Danish Health Authority has drawn up 11 prevention packages, which for the entire population describe prevention efforts which, in the short and long term, can strengthen and further develop the quality of the preventive and health-promoting work in the municipalities.

Initiatives That Promote The Mental Health Of The Elderly

This report presents a systematic literature study of international studies that have examined the effect of interventions that support the mental health of older people.

The purpose of the report is thus:

• to present a systematic review of the scientific literature that focuses on efforts that promote the mental health of older people
• to identify common features across the efforts that have the greatest effect on older people’s mental health
• to contribute concrete knowledge to municipalities and other actors who must develop initiatives that promote the mental health of older people

A definition of mental health

This report is based on the Danish Health Authority’s definition of mental health as a state of well-being where the individual can develop his abilities, can handle the challenges of everyday life, and participate in creating together with other people.

The mental health of the elderly thus depends on a complex interplay between individual resources and contextual conditions.

In addition to the individual’s well-being, the definition also emphasizes the social aspect and the importance of the elderly’s interaction with different communities.

Results: Initiatives that strengthen the mental health of the elderly

On the basis of the 50 studies that focused on the elderly themselves, regardless of whether they lived in their own home or in a nursing home, a number of common features were identified that seem to be important for the effect of a given effort:

• Characteristics of the elderly

The effect of interventions for the mental health of the elderly depends to a large extent on the elderly in question, which the intervention includes.

It is central to the effect of an effort that older people are motivated to participate. This is supported by meeting each individual’s individual preferences and needs. It is essential that the participants can see a point in the effort and experience that it is relevant to them. At the same time, it is crucial that the functional level of the elderly person is taken into account. This means that the effort is continuously adapted to the cognitive, physical and health-related functional level of the elderly.

For elderly people in their own homes, more comprehensive interventions may be appropriate (due to a higher level of function), while simple interventions may be preferable for elderly people in nursing homes.

• Content and structure of the effort

The specific content and structure of an effort also play a role in relation to the impact on the elderly’s mental health.

Across studies, especially those that focus on physical activity level, there is a tendency for efforts that contain social aspects or are group-based to play a decisive role in achieving a given effect. It also has a beneficial effect when health professionals are involved and contribute with ongoing supervision and feedback to the participants in the efforts. Finally, the scope of the effort is important for how well it works on the mental health of the elderly. Efforts should extend over a longer period of time and contain more activities.

However, it is essential that the scope is adapted to the participants’ individual cognitive and physical functional level.

• Implementation of the effort

The extent to which an effort is implemented is decisive for how effective the effort is. It is central that the individual parts of the effort are observed and carried out as planned. It is of decisive importance whether older people participate sufficiently in the effort and follow the planned activities. An effective way to ensure lasting implementation of an effort can be via the initial involvement of the healthcare staff, as well as ongoing supervision and feedback from them.

Municipal Prevention Initiatives For The Elderly

The study’s target group is the elderly, with a particular focus on the frail elderly. The survey uncovers prevention initiatives or efforts for citizens over 65 years of age. In addition, there is a special focus on efforts aimed at frail elderly people. Frail elderly must be understood according to the following definition:

Frailty is a clinical condition and is defined as a medical syndrome. Old age and frailty are not the same, but there is a coincidence between functional problems, a high number of chronic diseases and frailty, which is why the syndrome occurs more frequently with increasing age. Frailty can be manifested by weight loss, fatigue, low muscle strength and slow walking, and can also mask serious illness.

Frailty in the elderly is associated with an increased risk of loss of function, institutionalization and earlier death, but frailty is also considered reversible and to some extent preventable. Frail does not necessarily mean sick elderly or elderly in poor health, but elderly who are in special risk groups and where preventive initiatives can make a big difference.

The project must identify successful preventive efforts.

Preventive efforts can be divided into three levels (see figure 1.1):

1. the primary prevention, even before there are physical or psychological problems,
2. the secondary prevention, where problems are tried to be detected and treated early and
3. the tertiary prevention, which must prevent relapse after illness or injury.

The study uncovers the first two levels: primary and secondary prevention. The study thus focuses on the efforts to prevent contact with the rest of the healthcare system.

The preventive efforts in the study are based on 8 of the Danish Health Authority’s prevention packages with recommendations for the elderly.

This means preventive activities regarding:

• Alcohol
• Tobacco
• Overweight
• Food and meals
• Physical activity
• Hygiene
• Mental health
• Sexual health

The study was carried out through interviews with informants in 25 of the country’s 98 municipalities.

The municipalities have been selected on the basis that both large and small municipalities, urban and rural municipalities and municipalities throughout Denmark must be represented. For each municipality, we have interviewed a person in the municipality with an overview of the prevention and elderly area. The procedure is detailed in the study’s method chapter (section 2).

For each of the municipalities in the study, we have uncovered the municipality’s successful prevention efforts. On the basis of the survey, we have selected 12 interventions, which we have examined in more detail through case studies. The successful efforts are designated based on the municipalities’ assessment of where they have succeeded in recruiting, retaining and motivating older people to participate.

The report is structured so that this introduction ends with a brief summary of the survey results. The method used in the study is then described in chapter 2.

In chapter 3 follows a 4 description of the successful efforts that we have uncovered through the study. Chapter 4 highlights the good experiences from the municipalities in their work with preventive measures for the elderly, while Chapter 5 deals with the most significant barriers.

In chapter 6, 12 cases are reviewed, which are good concrete examples of municipal preventive efforts for the elderly.

Elderly Health And Well-being

Background

The proportion of elderly people in Denmark is increasing. Persons aged 65 and over thus made up 16% of the entire Danish population in 1990, 19% in 2017 and are expected to make up 24% in 2050 [1]. The growing elderly population will thus have an impact on the extent of a number of matters of social relevance, as regards the preventive and treatment efforts of the health and elderly sector, but also the efforts in a number of other specialist areas (for example the social area, the cultural area, physical planning, etc. .), which must contribute to creating good living conditions for the elderly. It is therefore important to focus on the state of health among the elderly. Against this background, the Ministry of Health and the Elderly and the National Board of Health have requested the Norwegian Institute of Public Health (SIF), SDU, to prepare a report with basic information on the elderly population’s health behaviour, state of health, morbidity, mortality and use of the healthcare system.

Purpose

The purpose of the report is to provide a broad description of the health status of the elderly population at national level and also to shed light on educational differences among the health status of the elderly. The report is aimed at practitioners and decision-makers who work with the elderly and health, and provides a picture of the health status of the elderly population in 2017 and the development since 1987.

Delimitation of the elderly group

There are many different definitions of the elderly group. Socially, the elderly group could be defined by the national pension age, but this definition is changeable and varies depending on the year of birth. For some purposes, this demarcation is therefore less appropriate. There is also no natural biological demarcation of the elderly group, as most age-related changes start already at the age of 30 and continue without abrupt transitions. In this report, it has been chosen to limit the elderly group to people aged 65 or over, with a sub-division into three age groups: 65-74 years, 75-84 years and 85 years or over. This has been chosen as it is considered to be the most natural demarcation.

Analysis Of The Transition From Working Life To Retirement Life.

The seniors’ experience of the transition from working life to retired life

The analysis sheds light on how the transition from working life to retirement is experienced by seniors who are about to or have recently retired.

The analysis includes people with many types of education, conditions and wishes, and therefore there is no single answer to what a good transition to senior life looks like.

Nevertheless, there are a number of common features and themes that recur, regardless of educational background and job situation.

Several of the future and new pensioners emphasize the general perception that there is a “tale about the good pensioner life”.

It is expected that retirement is a free space where you can pursue your interests and “get away from” working.

For many, however, leaving the labor market is not only positive, and therefore the narrative can be experienced as limiting, unrealistic and taboo in relation to the seniors’ personal experiences of what the transition actually entails.

They point to a need to nuance the narrative in order to get a more realistic picture of the transition to retirement.

When and how does the transition take place?

We have met many different perspectives on the good transition to retired life, and there is a big difference in when, why and how the interviewees want to retire.

What is crucial is that the withdrawal can take place in a dignified way, and that you yourself can influence when and how the transition takes place.

Some seniors have experienced that they were pushed out of the labor market due to new requirements for documentation, for working hours, efficiency requirements and new technology.

Others stop prematurely because of their own health challenges or that of their loved ones. Conversely, the economic situation can contribute to seniors staying on the labor market longer. The possibility of a gradual tapering off is also highlighted as central. This could be a senior scheme with weekly days off, a less demanding role in the organization and the like.

Life as a new pensioner

In the interviews, we have shed light on the seniors’ preparation for life as a pensioner and their reflections on what is important to have a good retired life. Six key trends can be identified:

Preparation for senior life is important for a smooth transition. It deals with, among other things, about exploring the possibilities of getting involved in the local community with voluntary work and building networks outside the workplace, so that there is still something to stand up for and create meaning when you step out of the labor market.

In addition, finances are central to a good retired life, and the vast majority of those interviewed have received advice on their financial conditions. A good economy allows for travel and activity and can thus create the basis for a good retirement life.

The experience of being able to make a difference and have meaning in life with voluntary work and social communities is important for many. Volunteering gives both the opportunity to do something for others and at the same time build a new social network.

Physical activity is also highlighted as an element of a good pensioner’s life. The interviewees mention a wide range of sports from walking the dog to tennis, golf and running as activities they would like to spend time on in retirement.

Most people emphasize being able to be active in their retired life – regardless of whether it is voluntary work, card clubs or physical activity. Here, it is important that there are opportunities in the immediate area, so that it is easy to participate in activities with a local anchorage.

Finally, family and close relationships are highlighted as an essential element in a good transition to senior life. The opportunity to spend time with spouse, children, grandchildren and friends etc. is highlighted as contributing to a good retirement life.

Vulnerable And Fragile Elderly

CASES

Eight cases from Spain, the Netherlands, England and Norway are presented and show a breadth of the way in which vulnerable and frail elderly people are worked with in the selected countries. The efforts rely largely on volunteers, but how, for what and to what extent volunteers are used varies.

The first three cases, Radars, The Silver Line and Kirkens Bymisjon , illustrate how volunteers and municipal authorities and services can collaborate on detection and follow-up efforts for citizens, and there is a focus on how this collaboration can be organized and coordinated internally within one’s own organization and under municipal auspices.

The fourth case Men’s Sheds is one of two gender-based efforts, and the men in the target group see and express themselves as members rather than users of an offer.

The main emphasis is on follow-up efforts, but there are also guides to workflows and procedures that can be obtained from the overall national association.

Cases five and six, Friendship Enrichment Program and Vallen Verleden Tijd (Fall belongs to the past), differs from the first cases, as they are based on teaching and exercises that must be reviewed and learned. The elderly work with themselves, and they can be characterized as purely health-related follow-up efforts. The tracking is also self-initiated, although it is possible in one case to be referred to the course. The last two cases, Model for good cooperation and FOCUS, are respectively a cooperation model and a tool for tracing, just as in case eight, work is being done with a series of follow-up efforts for the elderly who have been traced using the tool. The tool has been prepared from a healthcare perspective, and the model for good cooperation between volunteers and the municipality shares this healthcare perspective on follow-up efforts.

12 Scenarios For The Elderly Of The Future.

The themes The scenarios are divided into three themes.

The first theme is about late adulthood as it will unfold for future generations of older people. Here we ask partly how the health and lifestyle of the elderly will develop in the future, partly how future society will view the elderly and ageing. Will the elderly become increasingly healthy in the future, or will the development stagnate or perhaps even reverse? And will aging be considered a natural extension of the rest of life, or will we rather see it as a completely distinct life phase?

The second theme is about the technology that will have an increasingly large place in the welfare service in the future. Here we ask partly what role the technology will play for the processes it must be part of, and partly what attitude the citizens of the future will have towards technology. Will we primarily experience technology as limiting or facilitating? And do we primarily want to trust or distrust it?

The third theme concerns the welfare society of the future and the support it can provide to an aging population. Here we ask partly how welfare is to be financed in the future, partly what role family and civil society will play. Will the emphasis be on public funding of welfare or will private funding and user fees dominate in the future? And will the care for the elderly primarily be provided by formal means as now, or will informal help from family and networks take over?

The scenarios

The three themes with two questions each form a total of 12 possible outcomes or scenarios. Each scenario describes the consequences of this particular development in a number of areas:

• What does the scenario mean for society’s costs and for the future security of the welfare model?
• What development will we see here in terms of cohesion and the role of the public sector?
• How is working life and the possibilities for withdrawal affected, and how does nursing work develop in this particular scenario?

NO ONE CAN PREDICT the future, but based on the results of the MATURE project – and on the other research and practical knowledge in the area – we can outline some possible “futures” for the aging welfare society. The 12 scenarios should not be seen as definite proposals for a future development, but rather as exercises in our analytical imagination – exercises that provide an opportunity to triangulate research results, theories, social trends and localized knowledge at once, and on that basis facilitate new perspectives on the future. The booklet’s 12 scenarios are divided into three themes: Late adulthood, Technology in welfare services and Future welfare society.

These are areas that are each absolutely central to the future of services for the elderly, and where we can expect significant development in the next 20 years. However, which direction it will go in is uncertain. Each theme therefore contains two questions, the possible answers of which, combined with each other, give four outcomes or scenarios.