Report on Healthy Ageing Executive Summary

• Chapter 1 Introduction
• Chapter 2 Ageing Population
• Chapter 3 Concepts of Health, Ageing and Healthy Ageing
• Chapter 4 Physical Well-being
• Chapter 5 Psychosocial Well-being
• Chapter 6 Vision and Values
• Chapter 7 Promote Personal Responsibility
• Chapter 8 Strengthen Community Action
• Chapter 9 Create Supportive Environment
• Chapter 10 Improve Image of Ageing
• Chapter 11 Way Forward

Chapter 1 Introduction

• The promotion and maintenance of good health among the current and the next generation of older persons presents a special challenge not only to the older persons themselves, but also to the political, social and health leaders of the community.  An Ad Hoc Committee (the Committee) was set up under the Elderly Commission (EC) to map out strategies and initiatives to promote Healthy Ageing.

• In Hong Kong, there was an estimated 759 200 older persons (aged 65 and over) in 2000, accounting for about 11.2% of the total population.  By 2021, 15.7% (1 322 500), i.e. one out of six Hong Kong people, will be aged 65 or over.  The proportion of elder olds?(i.e. those aged 75 and over) within the aged population will rise sharply, as the baby boomers turn 75.
• A recent local survey has shown that 75% of local people aged 65 or over, and 45% of people in the 45 to 64 age groups are suffering from one or more chronic diseases, with diseases like diabetes, heart disease and chronic bronchitis common among the older persons.  In terms of the impact of these chronic diseases and conditions on the health system, over 46% of the hospital day-beds are occupied by older persons while they represent only about 11% of the total population.  If these impacts are not promptly and appropriately attended to, the economic implications of the high prevalence of chronic diseases in the older population can be considerable in terms of the medical interventions, rehabilitation and institutional care required.
• On the other hand, many chronic diseases are the cumulative effect of individual lifelong lifestyles and environmental influences.  Injuries and neuropsychiatric conditions are the two major causes of disability. Common injuries amongst older persons are caused by fall or accidents. Depression and dementia are the two most common mental conditions that deserve greater attention amongst older persons.
• With effective health protection and promotion, many of these diseases are preventable, and a significant proportion of disability in older persons is potentially reversible. The promotion of Healthy Ageing as a concept and as a practice among the Hong Kong community is therefore timely and worthwhile, both from an individual and societal perspective.

• Health is defined by the World Health Organization (WHO) as a state of complete physical, social and mental well-being.  It is not merely the absence of disease or infirmity.  Hence, in discussing health, the focus should be on optimizing the individual functioning including the body and mind.
• While ageing is an integral, natural part of life, the rate of physiological decline due to ageing varies from person to person.  The overall physical and psychological functioning of the body can be modified by a person adaptive capacities and coping skills.  To the extent that an older person remains healthy and intellectually active, the decline in mental function can be slight, and may not seriously impair his ability to enjoy life.
• The worldwide trend of an ageing population has prompted many overseas countries to adopt strategies on Healthy Ageing.  One of the important and resounding themes of countries or areas with Healthy Ageing initiatives is the viewing of ageing as a positive process full of opportunities and needs.  The common strategies on Healthy Ageing of these countries are:
  • promoting the adoption of a healthy lifestyle;
  • encouraging personal responsibility while providing support for those in need;
  • the Government to provide leadership, and work with other stakeholders, such as relevant professional associations, the voluntary agencies and the private sector jointly to promote healthy ageing to the general public;
  • promoting environmental changes in communities that will facilitate healthy living and ageing in place through the design of barrier-free communities and the development of caring support networks at the community level;
  • facilitating older persons to continue to take part in community, economic and social activities so as to ensure that they continue to lead an active and interesting life; and
  • taking steps to promote a positive image of ageing, placing emphasis on the possible contributions older persons can make to their family, the community and society.
  • The Committee recommends that similar strategies should be adopted in Hong Kong to promote Healthy Ageing.

• Sufficient physical activity, eating well and quitting smoking are important lifestyle factors that contribute to the prevention of many diseases.
• Physical activity is one of the most important things a person can do to maintain his physical and mental health and quality of life as he gets older.  Even older people with physical limitations and chronic conditions can benefit by becoming more active.
• An imbalanced diet may also be a contributory factor to many common diseases.  Maintaining a healthy diet is important for people of all ages.
• Smoking-related diseases such as lung cancer, chronic obstructive pulmonary diseases and coronary heart disease are major causes for mortality and morbidity in Hong Kong.  Smoking also accelerates osteoporosis and is an important factor for certain types of dementia.  International studies have shown that the cessation of smoking brings about health benefits even among the very old.
• By leading a healthy lifestyle, people can expect not only to live longer, but also to enjoy the added years as they stay healthier.

• Psychosocial aspects of life, e.g. a person history, social relations, lifestyle, personality, and mental (including cognitive) processes have significant health implications.  Of these factors, cognitive and social functioning are the two most important aspects of ageing that impact on the psychosocial well-being of older persons.
• A loss of cognitive functioning is neither inevitable nor irreversible as one ages.  It is possible to improve one memory performance by devoting more time and effort to process memory.  The minor loss of cognitive functioning can also be more than compensated for by the increased wisdom resulting from the older persons?enriched life experience.   
• Retirement from work, and the passing away of friends and close relatives, can bring about limitations in the older persons?social network, and may result in social isolation.  While traditionally, families in Hong Kong have been the main provider of care and emotional support, with rapid socio-economic developments, more and more older persons are being dissociated from their families.
• To promote the psychosocial well-being of older persons in Hong Kong, they should be encouraged to-

(a)    prepare for late adulthood;(b)    maintain harmonious interpersonal relationships;(c)    make positive use of their time;(d)    participate in community activities, to attain a sense of achievement and worthiness; and(e)    develop a realistic and philosophical outlook on life.

• Healthy Ageing should be looked upon as a total life-course approach in attaining optimal physical and psychosocial well-being. It begins with people who are basically healthy, and seeks the development of public policies, community and individual measures which are conducive to Healthy Ageing.
• The vision of the Committee is to create a society with a sustainable supportive environment that enables all persons, including older persons, to have access to information, services and support so that they can make responsible choices regarding their health and well-being, and to live independently as valued members of the community for as long as possible.
• To facilitate the development and the management of Healthy Ageing initiatives, we advocate the following set of values:
  • Respect and Dignity for Older Persons
  • Achievement of Holistic Health and Well-being
  • Promotion of Quality of Life
  • Striking a Balance between Self-Reliance, Family and Community Support
  • Importance of Multi-sectoral Collaboration
  • Evidence Based Practice.
• To assist the Government, Non Governmental Organizations (NGOs) and other local organizations in formulating policies and developing programs that are supportive of Healthy Ageing, nine guiding principles are proposed to be adopted:

(a)    the diverse needs, circumstances and aspirations of older persons should be addressed;(b)    older persons should be integrated and not separated, segregated and isolated from the rest of society;(c)    the accomplishment and contribution of older persons should be honoured and respected;(d)    stereotypes and misconceptions about older persons should be dispelled;(e)    self responsibility, capacity building, and the opportunity for creativity and innovation for older persons should be supported;(f)    active and meaningful participation of older persons in daily affairs and decisions that are important to them should be promoted;(g)    family support for older persons and intergenerational cohesion should be promoted;(h)    barriers including financial, physical and other hardships experienced by older persons and their caregivers should be overcome; and(i)    a supportive environment for healthy ageing in various settings, including in schools and the workplaces, etc. should be fostered.

• To realize the proposed vision, values and principles of Healthy Ageing, the Committee proposes to follow four strategic directions which are set out in Chapters 7-10.

• Personal lifestyle is probably the most important singular factor in affecting an individual health.  The role of the individual in exercising self responsibility is thus a very significant determinant in ensuring Healthy Ageing. 
• An effective way to promote personal responsibility is to empower the individual, such as to increase his ability to cope with a new challenges (such as diseases or stressful life events).  Measures such as regular health screening, timely medical consultation and the wise use of medication are important to enable the individual to make decisions that may lead to an early intervention and a speedy recovery from diseases.
• Some strategies to promote self-responsibility include: public education; involving older persons in the making of decisions and setting of expectations for how they will live; enhancing public access to information on health; and fostering self-efficacy among the elders through the acquisition of personal skills.

• As an individual lifestyle is susceptible to community influences, the promotion of Healthy Ageing will have a greater chance of success if different sectors of the community can work together to give support to our older population.
• To help focus community efforts, the Government should take the lead in raising the overall awareness on Healthy Ageing by engaging in sustained public education and publicity work. 
• Other participants can include the welfare sector NGOs, local bodies such as the District Councils and Area Committees, volunteers, the business sector, health care professionals, academia, and the media.  Successful personalities and celebrities can also mobilize community attention and form a social trend by advocating Healthy Ageing.

• An older person friendly environment should safeguard the safety and enhance the functional independence of older persons by including safety features (e.g. ramps and adequate lighting), prosthetic aids (e.g. large print directional signs), and self maintenance supports (e.g. handrails on tubs).
• As older people account for a rising proportion of the population, the concept of universal design should be widely promulgated and practised.
• A supportive social environment can help to sustain healthy practice. The holistic health movement is an emergent social trend in other countries which encourages people to adopt a healthy lifestyle and assume greater responsibility for their health. We should foster a similar movement by advocating the concept of healthy family, healthy school and healthy workplace.
• Intergenerational support is important to reinforce older persons efforts in adopting and maintaining a healthy lifestyle.  A cohesive family provides emotional support and informal care to the older persons and is an important agent to support compliance of good health practice.
• The school can play an important role in promoting Healthy Ageing at an early stage of an individual life, and in instilling a sense of respect for older persons among the young.
• In a healthy workplace, employees feel more in control of their life, and that they are usually more alert, innovative and productive.  The management, would benefit from reduced absenteeism, improved productivity, reduced medical costs and lowered accident rates.

• There are many stereotypes of older persons that contribute to biases.  Some of these biases, if internalized by older persons, would have serious consequences on the subjective well-being of the older persons.  Other biases, for example that older persons are an economic burden, may result in discriminatory behaviours against the older persons by families and the general community.
• Many overseas and local studies have helped to debunk these stereotypes.  For example, contrary to the common belief that a person physical and mental health deteriorates precipitously at old age, it has been found that the greatest decline in the human body actually occurs between 30 - 40 years of age.
• To combat these stereotypes, we should enlist the support and co-operation of the mass media in changing the community mindset about the stereotypes of older persons.  We should also encourage older persons to be proactive in establishing a positive image by pursuing continued education, continued employment, and volunteerism.

• As the concepts of Healthy Ageing are comparatively new to Hong Kong, the EC and its Committee, with the support of the Health and Welfare Bureau (HWB) and concerned departments, will take the lead to explain the concepts and the strategies to the community and the service providers, and to initiate community wide discussions on Healthy Ageing.  This will be done in the short term through a three year campaign on Healthy Ageing.
• The focus in the first year of the campaign will be on the promotion of physical well-being, highlighting the benefits of a healthy lifestyle for the whole community, particularly for the older persons.  This will be followed by the promotion of psychosocial well-being in the subsequent two years with continued reinforcement on the promotion of physical well-being.
• To encourage extensive community participation, the Committee will also launch a Community Partnership Scheme (CPS) aimed at rallying multi-sectoral participation in the promotion of Healthy Ageing by supporting innovative projects and programs on Healthy Ageing.  CPS is supported by a generous grant of $21 million from the Hong Kong Jockey Club Charities Trust.
• The Committee acknowledges that efforts to promote Healthy Ageing in Hong Kong should be sustained and perhaps further refined as we gain more experience.  A Steering Group will be set up to oversee the organization of the three year campaign, and to tender advice to the EC on future developments.