Healthy Ageing Strategy - Ministry of Social ...

 
Healthy Ageing Strategy - Ministry of Social ...
Healthy
Ageing
Strategy
Healthy Ageing Strategy - Ministry of Social ...
E noho ora ana te hunga pakeke, e noho pai ana
i ngā tau o te kaumā tuatanga tae noa atu ki ngā
tau whakamutunga o te rangatira i roto i nga ringa
manaaki, ringa atawhai o te hā pori.
Older people live well, age well and have a respectful end of life in age-
friendly communities.

                  Citation: Associate Minister of Health. 2016.
             Healthy Ageing Strategy. Wellington: Ministry of Health.

                           Published in December 2016
                             by the Ministry of Health
                    PO Box 5013, Wellington 6140, New Zealand

                            ISBN 978-0-947515-84-3 (print)
                           ISBN 978-0-947515-85-0 (online)
                                      HP 6514

                     This document is available at health.govt.nz

            This work is licensed under the Creative Commons Attribution 4.0 International licence. In
            essence, you are free to: share, ie, copy and redistribute the material in any medium or format;
            adapt, ie, remix, transform and build upon the material. You must give appropriate credit,
            provide a link to the licence and indicate if changes were made.
Healthy Ageing Strategy - Ministry of Social ...
Foreword
Associate Minister of Health
Older New Zealanders are a large and growing
proportion of our population – by 2036, one in
four of us will be aged 65 years or older. We all
deserve our best support to age well, live healthy,
independent lives and to have a respectful end
of life.

I commissioned this revision of the         Government
Health of Older People Strategy to help     is committed to the goals of positive
ensure that the resources of our health     ageing, where older people age
system remain focused on providing          well and are healthy, connected,
that support and empowering people.         independent and respected.
It sets the direction for the health
                                            At its heart, the Healthy Ageing
sector and outlines the actions needed
                                            Strategy is about people. Its priority
to improve the health outcomes and
                                            is adding life to years not just years
independence of older people in a
                                            to life. People age in different ways,
sustainable way.
                                            and our population is diverse. We
I have rebranded it the Healthy Ageing      must recognise the range of ways
Strategy for several reasons. We are        older people access and interact with
all ageing, in different ways, and don’t    services.
necessarily become ‘old’ when we
                                            We need a multi-faceted and
reach the age of 65. Healthy ageing
                                            coordinated approach to improve
recognises the diversity of older people,
                                            the health and wellbeing of our older
and ultimately seeks to maximise health
                                            people, particularly those living with
and wellbeing into and throughout
                                            long-term conditions, with high and
people’s older years.
                                            complex needs or in population groups
The Healthy Ageing Strategy is aligned      that are experiencing poorer outcomes
with the wider New Zealand Health           from our health system. Our health
Strategy. It also has strong links the      system also needs to meet the health
Positive Ageing Strategy. Older people      and support needs of an increasingly
make a significant contribution to and      ethnically diverse population.
have an integral role in our society. The

                                                        Healthy Ageing Strategy     iii
Healthy Ageing Strategy - Ministry of Social ...
This will require the health and social    Many people and organisations have
sectors to work collaboratively and for    been involved in developing this
everyone in New Zealand to recognise       Strategy. This reflects the wide variety
the important role that family and         of those who care about and influence
whānau carers play in supporting           older people’s health and wellbeing.
our older people in their homes and        I would like to thank everyone who has
communities.                               contributed.

As well as enabling and supporting         I would especially like to acknowledge
older people to age well, this Strategy    the input of older people and their
focuses on ensuring older people have      family and whānau carers. Your
a respectful end of life. Older people     contribution has been particularly
need to feel safe and supported to         important in helping shape the Strategy
openly discuss and plan their end-of-      and the services it provides.
life care. The health system needs to be
                                           Hon Peseta Sam Lotu-Iiga
responsive to older people’s wishes.
                                           Associate Minister of Health

iv   Healthy Ageing Strategy
Healthy Ageing Strategy - Ministry of Social ...
Foreword
Director-General of Health
With the release of the New Zealand Health
Strategy, now is the right time to set out a refreshed
strategy for the health of older New Zealanders –
the Healthy Ageing Strategy.

Its predecessor, the Health of Older         peoples’ health
People Strategy, was launched in 2002.       and wellbeing in
The 2002 strategy delivered many             later life.
successes, including greater choice in
                                             The Healthy Ageing Strategy has been
long-term health care services. We can
                                             written with this goal in mind. It has a
all be proud of that.
                                             strong focus on prevention, wellness
However, the social and demographic          and support for independence. It also
picture in our country has changed           recognises the importance of family,
over the past 14 years. In 2002,             whānau and community in older
when the current strategy was                people’s lives. It gives greater priority
published, those aged over 65 made           to equity and supporting the most
up 11.5 percent of the New Zealand           vulnerable, including those with high
population. That amount has now              and complex needs and in the final
climbed to 15 percent and is set to          stages of life. In addition, it signals the
climb further. This has significant          need for government agencies, health
implications for policy, planning, service   care providers and all who seek to
design and delivery.                         make a positive difference to health
                                             and wellbeing to work together. Better
We must ensure our health system
                                             integrating health and social responses
provides the care, support and treatment
                                             will help us to be more responsive to
that older New Zealanders need and that
                                             New Zealanders’ needs and choices.
level of care is sustainable. We want a
health system that works for every older     The five New Zealand Health Strategy
New Zealander.                               themes support the Healthy Ageing
                                             Strategy actions. These themes –
Achieving this means taking into
                                             people powered, closer to home,
account all the factors that impact on
                                             value and high performance, one

                                                          Healthy Ageing Strategy      v
Healthy Ageing Strategy - Ministry of Social ...
team and smart system – articulate         were involved in creating this strategy:
the wider system in which the goals        from individuals to families and whānau,
of the Healthy Ageing Strategy can be      carers, health professionals, service
achieved.                                  providers, government and non-
                                           governmental organisations. We all have
I believe this strategy provides us with
                                           an ongoing role to play in helping every
a clear focus and vision for where we
                                           older New Zealander live well, get well
need to head. As with the New Zealand
                                           and stay well.
Health Strategy, the Ministry of Health
will provide the leadership needed         I’d like to thank everyone who has
to help all the organisations involved     contributed to the Healthy Ageing
play their part in the required actions,   Strategy. I look forward to working with
changes and focus.                         you as we deliver it.

Leadership in this context is not about    Chai Chuah
being in charge or having all the          Director-General of Health
answers. Many people and organisations

vi   Healthy Ageing Strategy
Healthy Ageing Strategy - Ministry of Social ...
Contents
Foreword Associate Minister of Health                                                    iii
Foreword Director-General of Health                                                       v
Acknowledgements                                                                        viii
Why a Healthy Ageing Strategy                                                             1
Strategic context                                                                         4
Taking a life-course approach                                                             8
Challenges and opportunities                                                            10
Vision and priorities for action                                                        16
  Ageing well – Te pai o ngātau o te kaumātuatanga                                    18
  Acute and restorative care – Ngā tuāhuatanga manaaki, whakaora i te
  hunga māuiui                                                                         25
  Living well with long-term conditions – E noho ora ana i roto i ngā
  mauiuitanga o te tinana                                                               32
  Support for people with high and complex needs – He tautoko i te hunga
  pakeke he uaua, he maha hoki o rātau taumahatanga                                    37
  Respectful end of life – Te mate rangatira i ngā tau whakamutunga o te
  hunga pakeke                                                                          41
Turning the Strategy into action                                                        45
Action plan                                                                             48
References                                                                              68

                                                              Healthy Ageing Strategy   vii
Healthy Ageing Strategy - Ministry of Social ...
Acknowledgements
The Ministry of Health has received         • Dr Michal Boyd, Senior Lecturer,
valuable input from over 200 written          School of Nursing and Department
submissions on the draft Health of            of Geriatric Medicine, University of
Older People Strategy (now Healthy            Auckland
Ageing Strategy) by the closing date        • Stephanie Clare, Chief Executive,
of 7 September 2016. Five regional            Age Concern New Zealand
workshops also collected input from         • John Collyns, Executive Director,
hundreds of participants around the           Retirement Villages Association
country, including researchers, district
                                            • Hamish Crooks, Chief Executive,
health boards, clinicians, primary
                                              Pacific Homecare
health and other non-governmental
                                            • Dr Ken Greer, Clinical Advisor,
organisations, older people, carers, and
                                              Primary and Integrated Care, Capital
aged-care, Māori and Pacific providers.
                                              and Coast District Health Board
Earlier rounds of engagement                • Vui Mark Goshe, Chief Executive,
workshops had provided a high                 Vaka Tautua
degree of confidence around the             • Julie Haggie, Chief Executive, Home
overall approach and themes of the            and Community Health Association
draft Strategy. The public consultation
                                            • Sir Matiu Rei, Director, Ora Toa
process on the draft focussed largely on
                                            • Robyn Scott, immediate past Chief
identifying whether the right actions had
                                              Executive, Age Concern New
been developed and given priority. Over
                                              Zealand
2000 people were involved in those
Strategy development workshops.             • Simon Wallace, Chief Executive,
                                              New Zealand Aged Care Association
The Ministry would like to particularly     • Sarah Clark, Director, Office for
acknowledge the contribution of the           Seniors (ex-officio member)
expert advisory group:
                                            • Blair McCarthy, Acting Director,
• Dr Janice Wilson, Chief Executive,          Office for Seniors (ex-officio
  Health, Quality and Safety                  member).
  Commission (Chair)

viii Healthy Ageing Strategy
Healthy Ageing Strategy - Ministry of Social ...
Why a Healthy Ageing
Strategy
Everyone is ageing, and everyone wants to age well. That New
Zealanders are living longer than ever before is a major success story,
and many older New Zealanders are healthy, active and resilient.

                                                 Healthy Ageing Strategy   1
Healthy Ageing Strategy - Ministry of Social ...
Remaining in good health, ageing well       ‘old’ at any particular age or in the same
and being able and supported to live        way. Ageing is only partially associated
well with long-term conditions, however     with chronological ageing and it does
complex, is critical to enable older        not ‘start’ at 65. Some older people
people to continue participating and        remain independent and competent,
feeling valued (two important factors for   both physically and mentally,
health and wellbeing).                      throughout their older years. Some
                                            enter their older years with long-term or
We have a good base to build on, with
                                            chronic health conditions or disabilities,
many significant improvements to the
                                            and their needs become more complex
health and disability support system for
                                            as they age. Others develop disabilities
older people since the release of the
                                            and become dependent as they age,
2002 Health of Older People Strategy.
                                            due to cognitive and physical decline,
For example, we are supporting more
                                            and conditions such as dementia.
people than ever with long-term health
conditions and disabilities to remain in    We need to ensure our system is truly
their homes for longer. We also provide     people-centred and appropriate to New
more consistent and comprehensive           Zealand’s growing ethnic diversity.
needs assessments, greater choice and
improvements in the quality of home
                                              Our system and services must
and community services and aged
                                              aim to keep people in good
residential care. Moreover, access to
                                              health for longer, recognising
elective surgery has improved, as have
                                              that older people have
discharge practices.
                                              different needs at different
We want to maintain the positive              times.
changes we’ve seen over the last
14 years and improve on them in             People with the highest needs may be
the current context. Our operating          those who have the fewest resources
environment and the strategic context       and the least capacity to address those
in which we work have changed. We           needs.
need a new strategy that expands on         This document sets out a strategy for
the strengths of the past and sets the      the health and wellbeing of older people
direction for improved performance and      for the next 10 years.
outcomes across the board.
                                            It is the result of extensive engagement
The Healthy Ageing Strategy (the            with older people, their families, whānau
Strategy) is for older people, their        and carers, aged-care providers, health
families and their communities. Older       care professionals, professional bodies,
people are by no means a homogenous         researchers, Māori and Pacific peoples
population group. We don’t become           and their service providers, government

2    Healthy Ageing Strategy
agencies, district health boards              communication and empathy in
(DHBs), primary health organisations          health care, and for providers to help
(PHOs) and other non-governmental             older people articulate and listen to
organisations (NGOs) that represent           what is important to those people in
and support older people.                     their care
                                            • a call for more flexible services that
Hearing the voice of older people was
                                              respond to people’s individual needs
especially important in developing
                                              and diversity, but where people
this strategy, and many older people
                                              can expect to have the same level
provided feedback and were involved
                                              of access wherever they are in the
in forming the Strategy’s actions.
                                              country
They came from a wide variety of
backgrounds and offered many different      • a clear appreciation of the quality of
perspectives, aspirations and ideas           health care
about ageing.                               • an expectation for a highly
                                              integrated, well-coordinated,
While it is important not to generalise,      responsive health system
their feedback covered some notable,
                                            • acknowledgement of the tangible
consistent themes, including:
                                              benefits of technology, provided no
• the desire to be connected and              one is excluded or left behind.
  respected
                                            There are three parts to this document.
• a need to reduce barriers to
                                            The first part introduces the strategy
  participation in society, to keep
                                            and the context in which it exists.
  active physically, mentally and
                                            The second section presents the
  socially
                                            overarching direction for the health
• enthusiasm for age-friendly
                                            system for the next ten years with
  communities
                                            respect to the health and wellbeing of
• a keenness to be empowered to take        older people. The third section is the
  responsibility for their health, and to   action plan: specific actions we intend
  develop the skills to do so               to take to address the health and
• the importance of good                    wellbeing requirements for older people
                                            and achieve the desired outcomes.

                                                        Healthy Ageing Strategy        3
Strategic context
The New Zealand Health Strategy provides the overarching framework
and directions for our country’s health system.

4   Healthy Ageing Strategy
The New Zealand Health Strategy             The Disability Strategy was informed
describes the future we want, identifies    by the United Nations Convention on
the cultures and values that underpin       the Rights of Persons with Disabilities,
this future and sets out five strategic     ratified in 2008. The Healthy Ageing
themes for changes we can make that         Strategy is consistent with the articles
will take us toward its vision.             of the Convention.

 All New Zealanders live well, stay         Positive Ageing Strategy
 well, get well, in a system that is
                                            Government has a long-standing
 people-powered, provides services
                                            commitment to the vision and principles
 closer to home, is designed for
                                            of the cross-government New Zealand
 value and high performance, and
                                            Positive Ageing Strategy 2001, as
 works as one team in a smart
                                            reiterated in 2013 in Older New
 system.
                                            Zealanders – Healthy, Independent,
 New Zealand Health Strategy vision
                                            Connected and Respected.

The New Zealand Health Strategy              Older New Zealanders: healthy,
provides the building blocks for this        independent, connected and
Healthy Ageing Strategy. Together they       respected.
define how we will maintain and improve
                                             Cross-government New Zealand Positive
healthy ageing and independence,
                                             Ageing Strategy 2001
regardless of people’s health status, and
provide better support for older people
                                            Government agencies are working with
with high and complex needs and at the
                                            local government, towards a ‘vision of a
end of their lives.
                                            society where people can age positively
                                            and where older people are highly
New Zealand Disability                      valued and recognised as an integral
Strategy                                    part of families and communities’.
The New Zealand Disability Strategy
also informs the Healthy Ageing             Treaty of Waitangi and He
Strategy. It presents a long-term plan      Korowai Oranga
for:
                                            The health of older Māori is a priority for
 A society that highly values the           this strategy. We recognise and respect
 lives of people with disabilities          the special relationship between Māori
 and continually enhances their full        and the Crown through the Treaty of
 participation.                             Waitangi. In the health and disability
 New Zealand Disability Strategy vision

                                                         Healthy Ageing Strategy       5
sector, this involves working to the        ‘Ala Mo’ui – Pathways to
principles of:                              Pacific Health and Wellbeing
• partnership: working with iwi, hapū,      2014–2018
  whānau and Māori communities to
                                            ’Ala Mo’ui: Pathways to Pacific
  develop strategies for Māori health
                                            Health and Wellbeing 2014–2018 is
  gain and appropriate health and
                                            the Government’s national plan for
  disability services
                                            improving health outcomes for Pacific
• participation: involving Māori at all
                                            peoples, families and communities. ‘Ala
  levels of the health and disability
                                            Mo’ui has four priority outcome areas:
  sector, including in decision-making,
                                            • systems and services meet the
  planning, development and delivery
                                              needs of Pacific peoples
  of health and disability services
                                            • more services are delivered locally in
• protection: working to ensure Māori
                                              the community and in primary care
  have at least the same level of health
  as non-Māori, and safeguarding            • Pacific peoples are better supported
  Māori cultural concepts, values and         to be healthy
  practices.                                • Pacific peoples experience improved
                                              broader determinants of health.
    Pae ora: Healthy Futures
    for Māori                               Other national plans and
    wai ora, whānau ora,                    initiatives
    mauri ora.
                                            Other specific national strategies,
                                            action plans and work programmes
Our approach to improving Māori health
                                            influence the health of older people
is guided by He Korowai Oranga, Māori
                                            and guide programmes and services
Health Strategy. He Korowai Oranga
                                            on ways to meet their needs. These
has an overarching goal of pae ora,
                                            include:
which translates to healthy futures
for Māori. Pae ora comprises wai ora        • New Zealand Framework for
(healthy environments), whānau ora            Dementia Care
(healthy families) and mauri ora (healthy   • Improving the Lives of People with
individuals). Pae ora encourages              Dementia
everyone in the health and disability       • Primary Health Care Strategy
sector to work collaboratively, and to      • Living Well with Diabetes: A plan for
work across sectors to achieve a wider        people at high risk of or living with
vision of good health for everybody.          diabetes 2015–2020
Implementation of He Korowai Oranga         • The New Zealand Carers’ Strategy
across the health system recognises           and Action Plan 2014–2018
and respects the principles of the
Treaty.

6     Healthy Ageing Strategy
• Pharmacy Action Plan 2016–2020        Organization (WHO) Global Strategy on
• Rising to the Challenge: The Mental   Ageing and Health 2016–2020, a
  Health and Addiction Service          five-year strategy for action to maximise
  Development Plan 2012–2017            functional ability for all, and build the
• Review of Adult Palliative Care       evidence and partnerships for a Decade
  Services.                             of Healthy Ageing from 2020 to 2030.
                                        The Global Strategy’s five strategic
The Healthy Ageing Strategy             objectives are:
incorporates several aspects of these
                                        • commitment to action on healthy
population, service improvement and
                                          ageing in every country
condition-related strategies and work
                                        • developing age-friendly environments
programmes.
                                        • aligning health systems to the needs
                                          of older populations
Global Strategy on Ageing
                                        • developing sustainable and equitable
and Health                                systems for providing long-term care
Internationally, New Zealand is           (home, communities, institutions)
a signatory to the World Health         • improving measurement, monitoring
                                          and research on healthy ageing.

                                                    Healthy Ageing Strategy    7
Taking a life-course
approach
How well we age is influenced by our genetics, our upbringing, how
healthily we live in our younger years and throughout our adult life
and our exposure to health risks including poor housing, workplace
discrimination and family violence.

8   Healthy Ageing Strategy
Also highly influential are our physical                                 ageing’ does not refer to the absence of
and mental capabilities; our access                                      disease or physical or mental ill health.
to resources and opportunities;                                          WHO defines healthy ageing as ‘the
our resilience including in the face                                     process of developing and maintaining
of adversity; our relationships; our                                     the functional ability that enables
personal circumstances, including our                                    wellbeing in older age.’
occupation, level of wealth, educational
                                                                         Initiatives for older people that take
attainment and gender; our potential for
                                                                         a life course approach, promoting
personal growth; and our cultures and
                                                                         ‘healthy ageing’, focus on building
sense of identity, security, value and
                                                                         and maintaining people’s physical
wellbeing.
                                                                         and mental function and capacity,
This strategy applies a life-course                                      maintaining independence and
approach to achieving the aim of                                         preventing and delaying disease and
healthy ageing. It recognises that we                                    the onset of disability. Such initiatives
age in different ways and have different                                 aim to maintain quality of life for older
needs at different times, and that our                                   people who live with some degree of
health is affected by our environment.                                   illness or disability requiring short or
The approach involves enhancing                                          long-term care. They enable disabled
growth and development, preventing                                       people to do the things that are
disease and ensuring every person                                        important to them, enhancing their
functions to the highest capacity                                        participation, social connection and
possible throughout their life. ‘Healthy                                 appropriate care and ensuring their
                                                                         dignity in later years.
Figure 1: A life-course framework for healthy ageing
                                High and stable              Declining
                              Significant loss

                                                                                            Functional
                                                                                                ability

                                                                                              Intrinsic
                                                                                              Capacity

                  Prevent chronic conditions
Health services                                           Reverse or slow                     Manage
                  or ensure early detection
                                                          declines in capacity               advanced
                  and control
                                                                                    chronic conditions

                                                                    Support capacity-
                                                                    enhancing
Long-term care                                                                              Ensure a
                                                                    behaviours
                                                                                    dignified late life

                  Promote capacity-enhancing behaviours
Environments                                                         Remove barriers to participation,
                                                                      compensate for loss of capacity

Source: WHO 2015

                                                                                              Healthy Ageing Strategy   9
Challenges and
opportunities
New Zealand’s population is ageing. There will be a substantial
increase in the number of older people over the next decade.

10   Healthy Ageing Strategy
This older population, and our                   Currently, over one in six older people
communities, will also become more               are living with three or more long-term
ethnically diverse. The Māori population         conditions. Based on existing trends,
of people aged 65 and older is projected         an increasingly older population will
to increase by 79 percent in the 10 years        mean steadily increasing health care
to 2026. The older Pacific population is         needs. As a population group, older
expected to increase by 63 percent, and          people have much higher rates of long-
older Asian population by 125 percent in         term chronic health conditions, and
this same period.                                disabilities that require support on a
                                                 daily or regular basis.
The changing population has
major policy, funding and planning               We are living longer, but the age to
implications. We need to plan well               which we are likely to live in good health
to make sure we are well equipped                and without disability is not increasing
nationally, regionally, economically             at the same rate as life expectancy. At
and socially. We need to have the right          the age of 65, people can expect to
infrastructure in place to keep people in        live half of their remaining lives either
good health and provide for those who            free of disability or with functional
are not.                                         limitations that can be managed without
                                                 assistance.
Figure 2: Population projections by age group
with 10 year percent change                                 This is not the same for
Population (million)                                Age     all population groups. In
                                                    90+
5.5
                                                    85–90
                                                            a comparison of Māori
                               45%
 5                             40%                  75–84   and non-Māori males and
                               57%                          females, Māori males aged
4.5                                                 65–74
                               31%                          65 can expect the shortest
 4                                                  55–64
                                                            remaining time of living
                               13%
                                                            without disability or long-
3.5
                                8%                  45–54   term illness (5.5 years on
 3                                                          average) and the highest
2.5                                                         proportion of remaining time
                               14%
                                                    25–44   lived with disability requiring
 2
                                                            support (64 percent).
1.5
                                                            People with intellectual
 1
                                1%
                                                            disabilities have some of the
                                                    0–24
 .5                                                         poorest health outcomes
                                                            and can develop dementia
  0
2015/16                   2025/26               2035/36     at a younger age.
		                          Year

Source: Statistics New Zealand, 2016

                                                             Healthy Ageing Strategy    11
Figure 3: Māori and non-Māori life expectancy                                 for a whole-of-system approach
at age 65
                                                                               to achieving, balancing and
85                                                                             measuring improved health and
                                                                               equity for all populations, best
                                                                               value for public health system
80                                                                             resources and improved quality,
           80.4           82.5              84.1                86.6           safety and experience of care.

                                                                                To achieve equity, we need to
75
                                                                                understand and remove the
                                                                                barriers that prevent groups from
                                                                                experiencing equitable health
70
                                                                                outcomes, and build on the
           70.5          74.4               75.6               75.7             factors that enable equity. We
                                                                                need to work together with other
65                                                                              sectors to address a range of
          Māori         Māori         non-Māori           non-Māori
          males         females           males               females           barriers. The existing barriers we
                                                                                know about are infrastructural,
     Years with disability		      Years without disability
                                                                                financial and physical. Others can
Source: Ministry of Health, 2013                                                be difficult to articulate or identify.

                                                                       Figure 4: New Zealand Triple Aim
Health inequities                                                      Framework
                                                                                              re

We need to continue our efforts to
                                                                                                 Im
                                                                                            ca
                                                                                                   pro
                                                                                          of

reduce inequities in health, so that all
                                                                                                    ve
                                                                                         ce

                                                                                                      dh

population groups can enjoy good
                                                                                      en

                                                                                                      ea
                                                                                      eri

health and participate fully in family
                                                                                                         lth
                                                                                     xp
                                                                                    de

                                                                                                          an

and community life. In this respect, the
                                                                                                           de
                                                                                                    Po
                                                                                 an

                                                                                         al
                                                                                      du

                                                                                                      pu

                                                                                                               qu
                                                                                ty

Ministry of Health (the Ministry) focuses
                                                                              afe

                                                                                     ivi

                                                                                                         lat

                                                                                                               ity

                                                                                           Quality
                                                                                    Ind

specifically on the health of Māori,
                                                                                s

                                                                                                         ion

                                                                                                                for
                                                                            ty,

                                                                                         Improvement
                                                                                                                    all
                                                                          ali

Pacific peoples, migrant and refugee
                                                                        qu

                                                                                                                     po

communities, people with disabilities,
                                                                       ed

                                                                                                                     pu

                                                                                            System
                                                                      v

                                                                                                                      lat
                                                                  pro

people with long-term mental health
                                                                                                                          ion
                                                                 Im

                                                                                                                           s

conditions or addictions and people with                               Best value for public health system resources

low incomes, who experience persistent
                                                                       We need to better understand how well
inequities.
                                                                       our services are working for different
Achieving equity is a core component                                   population groups, and why problems
of the ‘value and high performance’                                    arise. This has implications for the
theme of the New Zealand Health                                        way that the health sector conducts
Strategy. This is underpinned by the                                   research, collects data and evaluates
New Zealand Triple Aim Framework                                       the effectiveness of services.

12     Healthy Ageing Strategy
Staying healthy and                          services. These approaches provide
independent in older age                     significant opportunities for improving
                                             the health of New Zealanders in general
We have an opportunity to reinforce
                                             and older New Zealanders in particular.
and accelerate the positive trends we
                                             One example of a social investment
have seen in recent years. By focusing
                                             approach might be a concerted effort
on preventing illness and by making it
                                             across government to reduce social
easier to choose healthy options (like
                                             isolation and loneliness, which we
eating healthy food, not drinking alcohol
                                             know have a strong relationship
or only drinking at low-risk levels, and
                                             with poor mental and physical
undertaking regular physical activity),
                                             health outcomes and with increased
we can help people to avoid developing
                                             problematic alcohol use.
long-term health conditions or slow
the development of those conditions.
Most importantly, we can do this by          Workforce development
providing universal health services
                                             The health system faces some
and public health initiatives that cover
                                             significant workforce challenges. The
the whole population and by having
                                             health of older people workforce is
services in place to intervene early and
                                             itself ageing and some key workforce
help people to return to good health
                                             groups have experienced recruitment
and remain independent. As part of this,
                                             difficulties. For example, forecasts show
we need tailored approaches for some
                                             that we will have trouble maintaining the
individuals and population groups, to
                                             necessary number of geriatricians and
help them access the same level of
                                             some other medical specialties, as well
service and enjoy the same outcomes
                                             as registered and enrolled nurses, in
as others.
                                             aged care.

                                             As people live longer with long-term
New investment approaches
                                             conditions and complex needs, either
If we continue to fund health services in    at home or in aged residential care,
the way we currently do, care of older       we will increasingly need to support
people will account for 50 percent of        and develop the skills of our nursing,
DHB expenditure by 2025/26, up from          allied and kaiāwhina (unregulated care
42 percent in 2015/16. It is vital that we   and support workforce) workforces.
ensure we are getting the best value         Some initiatives to sustain and grow
from the investments and resources           the workforce are under way, including
across the health and social sectors.        incentives to encourage graduate
                                             nurses to the sector and programmes
The Ministry and other government
                                             to support teams working together
departments are taking new ‘social
                                             across all settings. However, these are
investment’ approaches to funding

                                                         Healthy Ageing Strategy   13
not yet achieving significant gains. We        Many are led by older people, together
need to be smarter in the way we make          with local councils and a variety of
use of different parts of the workforce,       organisations, who work towards local
such as the well-qualified pharmacist          solutions to optimise older people’s
and allied health workforces.                  opportunities for healthy ageing,
                                               participation, security and quality of
We need to make a priority of attracting,
                                               life. Age-friendly communities provide
retaining and making the best use of
                                               new opportunities for developing
the skills in the health workforce to
                                               knowledge and skills for healthy ageing,
meet the needs of an older population.
                                               and for the health sector to partner with
We need to ensure workforce training
                                               older people in developing health and
keeps pace with technological change,
                                               resilience.
and retraining is easily accessible for
staff, and is efficient and effective.
                                               Integration across the
We also need to ensure that our health         health and social sectors
workforce appropriately reflects our
growing ethnic diversity and ensure that       Our approaches to the health and
it appropriately reflects and caters to a      care of older people need to change
diverse older population.                      at multiple levels. We need better
                                               communication between health service
                                               users and providers, to ensure that
Families and communities                       services are as effective and efficient
We also need to ensure that family and         as they can be. We need to improve
whānau carers receive support and              the abilities of families, whānau,
information to be able to appropriately        carers and communities to support
and safely care for older people. These        and help care for older people. The
carers should also be supported                health system needs to work with
to maintain their own health, and              other sectors to take joint action on the
undertaking a caring role should               social, environmental and economic
not exacerbate any existing health             determinants of people’s health. Good
conditions or disabilities.                    housing and transport, for example, are
                                               critical to keeping people well in their
We are starting to see the development         own communities.
of age-friendly communities in
New Zealand. This term refers to               More collaborative approaches will
communities that commit to physically          enable us to be efficient and innovative
accessible and inclusive social living         in the way we utilise specialist
environments that promote healthy and          roles, such as nurse practitioners,
active ageing and a good quality of life,      clinical nurse specialists and all
particularly for those in their later years.   health professionals including allied

14   Healthy Ageing Strategy
health professionals, such as dental        view of performance. Three of the
hygienists, dieticians, occupational        measures in particular (acute hospital
therapists and radiographers;               bed days per capita, patient experience
pharmacists and paramedics, to              of care and amenable mortality rates)
improve outcomes and enable                 highlight significant opportunities to
innovative models to develop in home        improve the health outcomes of older
care, primary health care and residential   people.
care.
                                            We’re also able to make use of
                                            new technologies and information
Smart system                                improvements. These technologies
Today’s health system is data-rich, with    and improvements include initiatives
a tremendous volume of information          that enable information to flow quickly
that can be harvested to create a much      and freely to older people and to health
smarter system.                             workers, providers and families and
                                            whānau; apps that provide immediate
The value and high performance theme        information on an older person’s
of the New Zealand Health Strategy          health status; and social media, which
emphasises the performance of the           improves health professionals’ options
whole system and recommends                 for connecting with older people,
the development of an outcomes-             families, whānau and carers in diverse
based approach to performance               or isolated communities and helping
measurement. The Ministry has               them to connect more easily with the
worked closely with the health sector       services and information they need.
to develop a suite of system-level          Improved information flows will also
measures that provide a system-wide         help agencies to collaborate more
                                            widely.

                                                        Healthy Ageing Strategy   15
Vision and priorities
for action
The vision for this Strategy is that: Older people live well, age well and
have a respectful end of life in age-friendly communities.

16   Healthy
     Healthy Ageing
             Ageing Strategy
                    Strategy
To achieve this vision, we need to              • better support older people with
ensure our policies, funding, planning            high and complex needs
and service delivery:                           • provide respectful end-of-life care
• prioritise healthy ageing and                   that caters to personal, cultural and
  resilience throughout people’s older            spiritual needs.
  years                                         These five outcome areas form the
• enable high-quality acute and                 framework for this Strategy. We will
  restorative care, for effective               set out to achieve our vision in these
  rehabilitation, recovery and                  five areas within a system that, as the
  restoration after acute events                New Zealand Health Strategy requires,
• ensure older people can live well             is people powered, delivers services
  with long-term conditions                     closer to home, is designed for value
                                                and high performance and works as
                                                one team in a smart system.
Figure 5: Strategic framework for healthy ageing

                                      People-
                                      powered

                                      Ageing
                                       well
     Smart                                                             Closer to
    system                                                              home
                     Support
                     for people                         Living
                     with high                       well with
                                    Respectful
                     and                               health
                                    end of life
                     complex                        conditions
                     needs
                                    Acute and
                                 restorative care

                                                          Value and
                 One team                                    high
                                                         performance

                                                            Healthy Ageing Strategy   17
Ageing well
 Te pai o ngātau o te kaumātuatanga
 This outcome area is about:
 • maximising people’s physical and mental health and wellbeing
   throughout their lives
 • developing health-smart and resilient older people, families and
   communities to help older people age positively
 • achieving equity for Māori and other population groups with poorer
   health outcomes
 • taking actions to improve the physical, social and environmental factors
   of healthy ageing
 • supporting the development and sustainability of age-friendly
   communities that enable older people to age positively.

18   Healthy Ageing Strategy
Why this is important                         Investing in healthy ageing has the
                                              potential to increase the proportion of
Health is fundamental to being able
                                              healthy, active and independent older
to live well, age well and continue to
                                              people, prevent long-term conditions
participate in family and community
                                              and their impacts on people’s lives and
life. Older people make a significant
                                              result in long-term savings to the heath
contribution to our society, economically,
                                              system.
socially and intellectually as mentors,
leaders and skilled workers and               A healthily ageing and robust
volunteers. A healthy ageing approach         population would help enable
seeks to enable older people to continue      individuals to continue participating
to be active, engaged and enjoying life.      in their communities and contributing
                                              economically, socially and intellectually
While people may experience some
                                              to a greater extent. Fewer people would
loss of strength and mobility over time,
                                              require acute health interventions
many of the conditions associated
                                              and would be able to stably maintain
with ageing (such as frailty) are not
                                              themselves if they developed chronic
inevitable. The WHO estimates that
                                              health conditions.
more than half of the health conditions
older people experience are potentially       To ensure people age well, we need to
avoidable through lifestyle changes.          focus on:
There is increasingly clear evidence          • building physical and mental
that healthy lifestyles and physical and        resilience
mental resilience are determinants of
                                              • achieving equity in health across all
health in older age. There are also many
                                                population groups
opportunities to benefit longer term from
                                              • developing a health smart population
investing in social and environmental
                                                through health literacy and helping
factors that influence health.
                                                people to plan for their future health
Ageing well is not just about preventing        and health-related needs
ill health and disability. It is also about   • a health system that supports healthy
maximising physical and mental health           ageing closer to home
and wellbeing, independence and               • supporting people to plan for future
social connectedness as people age.             health and health-related needs
Healthy ageing relates to all older
                                              • improving social, physical and
people, including people with life-long
                                                environmental determinants of health
disabilities or long-term conditions,
                                              • promoting and supporting the
those recovering from injuries or poor
                                                development of age-friendly
health, those with high and complex
                                                communities.
needs and those in their final stages of
life. Subsequent chapters build on this
chapter.

                                                          Healthy Ageing Strategy   19
Resilience                                  that promotes older people’s sense
                                            of self-worth and value to others.
Resilient people are more likely to age
                                            We need to continue to reduce the
well and avoid cognitive decline or
                                            stigma of depression and anxiety
loss of function until very late in life.
                                            among older populations, and promote
Resilient people can overcome stressful
                                            the factors and supports for greater
obstacles and recover from events that
                                            mental wellbeing. We need to foster
might tip a less resilient person into a
                                            approaches that build people’s
state of poor health.
                                            strengths and capabilities, increase
Resilience develops through physical        optimism and hope and reduce the
activity, healthy behaviours, mental        potential and impact of depression,
wellbeing and social connectedness.         anxiety and cognitive decline.
Our focus is therefore on increasing
physical activity and other healthy         Equity
behaviours among older people – for
                                            Reducing health inequities is a core
example, encourage good nutrition, not
                                            component of a healthy ageing
drinking alcohol or only drinking at low-
                                            approach and a priority for government.
risk levels, not smoking tobacco, taking
                                            Equity is defined by the WHO as ‘the
part in mentally stimulating activities
                                            absence of avoidable or remediable
and relationships that build people’s
                                            differences among groups of people,
strengths and resilience.
                                            whether those groups are defined
People staying active and connected         socially, economically, demographically
as they grow older is critical. There is    or geographically.’ Health equity
strong evidence that social isolation or    approaches aim to improve fairness
loneliness is linked to poor mental and     and reduce the incidence of avoidable,
physical health outcomes. We need to        undesirable differences in health status.
increase awareness of this fact across
                                            People differ in their ability to attain
the health system, and join with social
                                            or maintain good health, for many
sector agencies, as well as community
                                            reasons. Some population groups
and voluntary organisations to reduce
                                            have markedly poorer health outcomes:
this risk factor and increase social
                                            Māori, Pacific peoples, people with
interaction and connectedness.
                                            intellectual disabilities, and people
We must also improve mental                 in socioeconomically deprived
wellbeing among older people. Social        areas. Other groups, such as ethnic
connectedness, nutrition, physical          communities and rural communities,
health and activity all contribute to       are also vulnerable to poorer health
mental health, as does an environment       outcomes.

20   Healthy Ageing Strategy
Our focus on health equity aims to         Empowering and supporting older
increase the age which these groups        people to be ‘health smart’ in their later
can expect to remain in good health        years requires the health system to
and independence and includes:             have a strong understanding of what
• ensuring equity of access to health      it takes to age well and takes part
  services, including through innovative   in achieving healthy ageing. We will
  and effective services provided          support older people in a way that is
  closer to home, and catering to          meaningful for them, and that is fully
  people’s cultural preferences            inclusive, where people are at the
• enabling equal opportunities to raise    centre of the process. We will make
  the capacity, functional ability and     health information available and shared
  wellbeing, by directing resources at     in a way that overcomes cultural and
  those with greatest need                 communication barriers.

• removing physical, financial,            Planning for the future
  institutional and other barriers to
  high-quality health services and         People’s needs change as they age,
  equitable health outcomes                and there may become a time when
                                           a person is no longer able to make
• working across government and
                                           decisions or advocate for themselves.
  in communities on the social
                                           Advance care plans and enduring
  determinants of health, including
                                           powers of attorney allow an individual
  housing, elder abuse and neglect,
                                           to retain a degree of autonomy in
  negative attitudes and discrimination,
                                           relation to their health care and
  social isolation and inclusive, age-
                                           treatment, minimise the potential for
  friendly communities
                                           conflict or harm, and reduce stress on
• minimising the impact of disability
                                           family members and others. There is
  and illness on people’s lives.
                                           some evidence that advance care plans
                                           can improve the experience of end-of-
Being health smart                         life care and their use across clinical
Health literacy                            disciplines is an integral part of a dying
People are empowered in their              person’s coordination of care.
everyday lives when they can make          Advance care plans and the
decisions that positively affect their     discussions around them create an
health and care. Health literacy is the    opportunity for people to think and
capacity to make good decisions, act       talk about their values, preferences
on health information and navigate         and beliefs. These conversations are
the health system. It is an essential      easier when they begin well before
component of resilience and a priority     the end of life. However, as people’s
of this Strategy.                          preferences often change over time, it

                                                        Healthy Ageing Strategy   21
is also important that they be reviewed      A strong, well organised primary health
and updated at key points and when           care system that is provided close
circumstances change.                        to where people live and work will
                                             empower individuals, enabling them to
The New Zealand Health Strategy
                                             make informed choices and supporting
commits to supporting people and
                                             them as they navigate their way
their clinicians to develop advance
                                             through the health system. They also
care plans by building on existing
                                             reduce health inequities and improve
national and international resources
                                             population resilience.
and networks. We can also promote
advance care planning through, for
example, community organisations,            Improving the social and
to help reduce stigma around talking         environmental factors
about death and dying, and to increase       influencing health
the likelihood that people receive quality
                                             Together with other government sectors
health care according to their wishes.
                                             and communities, the health system will
The quality of care is further discussed
                                             work to improve the social, economic
in the ‘Respectful end of life’ section.
                                             and physical factors for healthy ageing
We know that financial security is also      and achieve equity, removing barriers to
important for mental wellbeing and           participation.
healthy ageing. The Commission for
Financial Capability is carrying out a       We need a coordinated, system-wide
national strategy and leading work           approach to preventing, identifying and
across government and together with          reducing elder abuse and neglect that
communities to grow New Zealanders’          includes providing accessible, well-
financial capability. Better financial       tailored, effective services. As part of
capability will improve family and           the Ministerial Group on Family Violence
community wellbeing, reduce hardship,        and Sexual Violence work programme,
increase investment and grow the             the health, social and justice sectors
economy, contributing to everyone’s          are working together to develop an
resilience.                                  integrated system for preventing and
                                             responding to family violence and
                                             sexual violence, including elder abuse
High-quality care closer to
                                             and neglect, and reducing the impacts
home                                         of such violence on wellbeing. The work
Primary health care services are             is built around people-centred service
generally people’s first interaction with    design and delivery, in the four areas
the health system when they are unwell.      of primary prevention, identification,
They are where people receive most of        incident response and follow-up
their professional medical advice.           responses.

22   Healthy Ageing Strategy
We will work with housing providers        Age-friendly communities
to improve the quality and range of        and workforce
age-friendly housing for older people.
                                           Age-friendly communities are
This will include a focus on rental
                                           accessible and inclusive. They value
housing stock, which older people
                                           people of all ages, and optimise
are increasingly likely to live in, and
                                           opportunities for healthy ageing,
supported living housing options. We
                                           including in the areas of participation,
will work with social housing providers
                                           dignity, security, and quality of life.
to ensure that social housing is warm,
                                           Age-friendly communities ensure
safe and dry, and with others to
                                           older people have a voice, including
promote options for housing that meet
                                           those with disabilities and dementia,
the needs of an ageing population.
                                           and marginalised older people. They
We will also look for opportunities with
                                           recognise older people’s wide range
the housing development sectors to
                                           of skills and resources, and ensure
understand the future housing needs of
                                           that communities protect those who
an ageing population.
                                           are most vulnerable. They anticipate
Transport solutions are needed to          and respond flexibly to the changing
reduce social isolation and improve        physical, mental and social needs and
older people’s ability to participate in   preferences of older people and ageing
their communities and access health        populations.
and other social services. Government
                                           The ‘age-friendly’ concept and its
agencies will work with transport
                                           implementation have significant
providers to increase access to
                                           momentum internationally and is
alternative means of transport for older
                                           starting to gain pace in New Zealand.
people, to help prevent isolation. They
                                           The Office for Seniors will lead the
will work to increase the flexibility of
                                           development, through a co-design
social services in areas where transport
                                           process, of a New Zealand-centric
options are most limited.
                                           approach, and further develop the
Whānau ora service approaches are          resources and networks to guide
examples of how agencies can work          communities through the process of
well together to reduce the social,        becoming age-friendly.
physical and environmental barriers
                                           Across central and local government
some people face to achieving good
                                           agencies, and in partnership with
health and wellbeing.
                                           communities, we will support older
                                           people and promote age-friendly
                                           communities throughout New Zealand.
                                           We will support older people and others
                                           leading age-friendly communities

                                                       Healthy Ageing Strategy   23
locally. Together we will work to           Goals for healthy ageing
improve policies, services, structures
                                            • Older people are physically, mentally
and environments, particularly outdoor
                                              and socially active, have healthy
spaces and buildings, transport,
                                              lifestyles and greater resilience
housing, social participation, respect
                                              throughout their lives, meaning that
and social inclusion, civic participation
                                              they spend more of their lives in
and employment, communication,
                                              good health and living independently.
and health and social services. Our
collaboration will enable collective        • Older people are health smart, able
impact at the national, regional and          to make informed decisions about
local levels.                                 their health and know when and how
                                              to get help early.
An integrated health workforce with         • Everyone in the health system and in
knowledge of social determinants of           the wider social sector understands
health, culturally competent and with         what contributes to healthy ageing,
a focus on wellness and upstream              and takes part in achieving it.
early intervention in supporting healthy
                                            • All older populations in New Zealand
lifestyles is an important contributor to
                                              are supported to age well in ways
age-friendly communities.
                                              appropriate to their needs and
                                              cultures.
                                            • Communities are age-friendly with
                                              initiatives to keep people healthy,
                                              well-connected, independent,
                                              respected and able to participate
                                              fully in their communities and with
                                              family and whānau.

24   Healthy Ageing Strategy
Acute and restorative care
Ngā tuāhuatanga manaaki, whakaora i te
hunga māuiui
This outcome area is about:
• ensuring appropriate admissions to hospital for older people with
  acute or urgent clinical/care needs
• coordinating care across specialities and between ACC and the
  health sector
• ensuring hospital stays are safe for older people who are frail,
  vulnerable or have dementia
• helping older people to regain, maintain or adapt to changed levels of
  function after an acute event
• looking for ways to weave family or whānau and wider community
  support into an older person’s recovery and ongoing functioning.

                                                    Healthy Ageing Strategy   25
Why this is important                        However, at the other end, premature
                                             discharge may result in loss of
Older people benefit from access to
                                             functioning or condition in the older
a wide range of hospital services,
                                             person or even readmission. Premature
including emergency or acute services.
                                             discharge can also cause significant
But unnecessary emergency visits, and
                                             stress for family, whānau and carers
inappropriate admissions are stressful
                                             who feel unprepared and unsupported.
for the individuals and use valuable
resources.                                   When an older person returns home
                                             after a stay in hospital, they may need to
Ambulance services and emergency
                                             make adjustments to their daily routines,
departments are generally the first
                                             and they may require temporary or
services to deal with acute and
                                             ongoing support. Re-integration to
potentially life-threatening situations.
                                             family, whānau and community life is a
But they may not be the best places for
                                             key goal at this stage.
older people whose conditions could
be managed at home or by their local         Successful treatment of an acute event
primary health care clinics or aged          and effective follow-up care are reliant
residential care homes.                      on proactive and integrated planning,
                                             timely treatment and a team approach.
Once in hospital, older people can
                                             Planning needs to involve the individual
be especially vulnerable to rapid
                                             and their family and whānau and should
deterioration putting them at risk of
                                             address physical, mental and spiritual
further harm, (eg, by acquiring an
                                             aspects.
infection).
                                             Service providers and staff need
When older people stay in hospital
                                             to understand cultural and other
too long, they face the risk of further
                                             preferences, and be committed to
decline in their health associated with
                                             working with Māori, Pacific and other
reduced physical activity (leading to
                                             organisations, families, whānau and
loss of muscle tone and the chance of
                                             community leaders to get the best
bed injuries), stress leading to increased
                                             outcomes possible for individuals.
confusion, and inappropriate medication.
                                             Older people told us that they want their:
These factors can lead to loss of
                                             • urgent care needs managed at the
confidence and social contact and
                                               right level (that is, don’t take them
are strong predictors of increased
                                               to hospital if they don’t need to go
length of stay, long-term cognitive
                                               there)
impairment, complications or death, as
well as higher costs for care. They can      • assessment and other important
also mean a slower recovery for the            information to be available to all who
individual and increased distress for          need it (that is, not to have to repeat
family, whānau and carers.                     their information several times over)

26   Healthy Ageing Strategy
• families, whānau and carers involved       Family and carers could be the ‘eyes
  in their rehabilitation and planning for   and ears’ of an older person’s care
  their return home                          team and initiate timely interventions.
• discharge, ongoing rehabilitation,         Some DHBs have developed ‘pathways
  home support and equipment                 of care’, that is, guidelines for assessing
  organised in a timely way.                 and managing particular conditions (eg,
Therefore we will focus on improving         strokes or heart disease) to improve
the three main parts of the journey          the coordination and documentation
for older people – managing acute            of care. Such pathways can reduce
presentations, providing safe, quality       unplanned referrals to hospital.
treatments in hospital stay, and             We need to spread innovations that
ensuring supported discharges and            reduce the need for unnecessary
rehabilitation into the community.           intensive services.

                                             Ambulance services in the Kāpiti Coast
Managing acute
                                             region, out of Wellington, are using an
presentations
                                             ‘urgent community care model’ and
To reduce unnecessary admissions,            Healthline, as well as frontline triaging in
we need a system-wide response,              emergency departments. Gerontology
including prevention, timely primary         nurse specialists in the Waitemata
health care responses for older              DHB provide assessments and care
people with acute needs, better              coordination across primary health
communication between providers and          care and hospital services for complex
systems, coordinated clinical and social     wound care to be managed in the home
care, links between regular hours and        or aged residential care setting, thus
after-hours services, and engagement         reducing the risk of an older person’s
with community providers.                    health deteriorating and the need for
                                             acute care.
The first stage of the journey is
prevention. A range of people can            We will encourage and support such
have a role in this stage, including         innovations, evaluate their outcomes
general practitioners, pharmacists,          and spread good practice.
physiotherapists and home support
workers. All these primary care              Safe, quality treatment in
givers should be able to recognise a         hospital
deteriorating or acute situation and know
where to go for further advice before        Hospitals can be frightening and
calling on emergency care services.          bewildering places. Hospital staff need
                                             to be acutely aware of the vulnerability
                                             of older people, especially those who

                                                          Healthy Ageing Strategy    27
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