The human population is living longer than at any other time in history, with global life expectancy doubling since the 1900s (World Health Organization (WHO), 2020). Someone aged 65 years old today can expect to live to 85, nearly 10 years longer than their parents' generation. By 2041, one in four people living in the UK, around 20.7 million individuals, will be aged 65 and over (Public Health England (PHE) and Centre for Ageing Better, 2021).
Despite living longer, many people do not experience good health in old age. Instead, they spend a large proportion of their later life managing multiple long-term conditions and disabilities, which could have been prevented, or the impact lessened, by actions taken earlier in their lives.
Aspirations to create opportunities for healthy ageing are prolific in national and international health policy. Defining the concept in terms of health and social factors, WHO states it is:
‘The process of developing and maintaining the functional ability that enables wellbeing in older age.’
Measures that support healthy ageing involve a combination of physical, cognitive, and social factors, many of which are more effective if implemented early in a person's life (see Table 1).
Table 1. Factors that promote productive healthy ageing
| Better physical health and mental wellbeing |
| Financial security and independence |
| Increasing resilience, with physical and cognitive reserves |
| Maintaining good social connections, friendships and practical help |
| Having a sense of meaning and purpose by engaging with others in activities, including high-quality work, caring or volunteering |
Enhancing the public's health in later years
Additional life years offer great opportunities for individuals, communities, society and the economy. However, for many people, living in deprivation and having pre-existing chronic disease and disability means they are unable to maintain functional ability and make the most of these opportunities (PHE and Centre for Ageing Better, 2021). To address this, the UK Government has an ambition for everyone to have five extra years of healthy life by 2035 (PHE and Centre for Ageing Better, 2021).
Evidence shows that promoting healthy behaviours from mid-life onwards allows people to prevent the onset of chronic diseases and prolong their physical and cognitive functionality into later life. For example, eating a healthy diet, taking regular physical exercise, which includes activities to increase strength and improve balance, stopping smoking and reducing alcohol consumption can all contribute to prolonging health and independence (PHE, 2016). Emotional, social, and cognitive health in old age have also been shown to benefit from strategies to engage and connect with others and avoid social isolation. Hobbies and focused activities that instil a sense of belonging and purpose have all been shown to enhance functionality in old age and thereby prolong health and independence.
All nurses have an important role to play in helping people prepare for healthy ageing. As the most trusted health professionals and the largest professional group in the UK's health and social care system, they are likely to meet people at several times during their lives. Taking each meeting as an opportunity to share information about behaviour change and healthy ageing will help people to understand the changes necessary to achieve health in later life (PHE, 2016; WHO, 2020).
Health messaging and behaviour change should be relevant and responsive to context changes affecting health and lifestyle. A recent report by PHE found that inactivity among older adults during the national lockdown of the COVID-19 pandemic, meant that many older people experienced a decline in their mobility, functionality, strength and balance and an increase in the number of falls they had (PHE, 2021). In future, to regain health in old age, these people will need support to increase activity and functionality during the recovery phase of the pandemic.
The report predicts that, without mitigation to reverse the decline, these people will suffer more falls and associated morbidity. Furthermore, research shows that health messaging is effective at all stages of a person's life, and earlier messaging can influence thinking in later life. This is especially important when considering the behaviour changes needed to prevent cognitive decline in old age (Livingston et al, 2020). Sharing information, providing support, and signposting to appropriate services all help individuals in later life to lead healthy, happy and active lives.
Enhancing knowledge and action on healthy ageing
To support all health and care professionals to enhance their knowledge and, more importantly, to take greater action on key public health issues such as healthy ageing, the Office for Health Improvement and Disparities has published free online e-learning resources as part of a programme entitled All Our Health (Health Education England (HEE), 2019). The healthy ageing e-learning resource aims to support professionals by providing bite-sized learning, focusing on the evidence for what works, and provides links to helpful data sources, guidance and further training resources.
Building back better and fairer
As we start to focus on the recovery phase of the COVID-19 pandemic, it will be essential for the nursing and midwifery workforce to appraise the lessons learnt and consider what changes need to be made to ensure that we genuinely build back better and fairer. This will require our profession to use the 2020s as a decade that sees transformation across the nursing and midwifery workforce, placing as much focus on preventing, protecting and promoting the public's health as we do on managing and treating disease.
Given our need to focus on productive healthy ageing, nurses must prioritise this area of practice as we move forward. The All Our Health programme provides a useful framework, allowing our profession to consider the evidence-based interventions that nurses can implement or champion at individual, community and population levels.
CASE STUDY
Sheriff Amir (not his real name) has recently retired and left a job that he had held for the past 35 years, while also moving home to another part of the country to be closer to his adult children.
He attends an appointment with the practice nurse at his GP surgery for some routine blood tests because he has been feeling generally unwell. He says he feels sad and some days he is too exhausted to leave home. As he lives alone, this means that he does not see another person all day, especially since he moved home after his retirement and has no friends locally.
Since taking up the position of health promotion and improvement nurse, the practice nurse has completed an audit of resources in the local community. With the help of the All Our Health e-learning resources, she has explored the benefits of increasing social contact opportunities for older adults registered with the practice. She knows that, professionally, Sheriff trained apprentices in the hospitality sector and really misses the opportunities to talk to people that his job gave him.
The practice nurse knows that the local community cafe is looking for someone to help train the volunteer waiting staff. Sheriff is keen to contribute once he feels better and agrees to visit the cafe the next day to talk to the manager.
All of Sheriff's blood results come back within normal ranges. The practice nurse next sees Sheriff when he returns several months later for his flu vaccination. He takes this opportunity to thank the practice nurse for the introduction to the community cafe because this has transformed his life.
Since joining the team of volunteers at the cafe, Sheriff is feeling much better. He is walking to the cafe 3 days a week, is enjoying helping the volunteers to learn and is particularly surprised when they thank him for his help.