Metrics and evidence for healthy ageing
Metrics and evidence for healthy ageing
复制标题
健康老龄化的指标和证据
DOI：
--
复制
发表时间：
2019
影响因子：
11.1
通讯作者：
Anshu Banerjee
中科院分区：
文献类型：
--
作者：
R. Sadana;Anshu Banerjee
792.世界卫生组织（卫生组织）对人口老龄化的反应是促进整个生命过程中的健康老龄化。健康老龄化是发展和保持使老年人能够获得福祉的功能能力的过程。1世卫组织《老龄与健康问题全球战略和行动计划》1于2016年获得批准，描述了各国政府、国际机构和其他合作伙伴可以采取哪些行动来满足老年人的需求和愿望。该行动计划呼吁转变政策和机构，使相互关联的行动能够包容多样性和缩小健康不平等现象。2需要多部门努力，将公共、私营、民间社会和非营利部门的利益攸关方，3包括老年人，聚集在一起，以适应环境，使人们能够做他们所重视的事情。关于老龄与健康的第二个行动计划，即“健康老龄十年（2020-2030年）”，正在编制之中。2020年，世卫组织还将发布全球基线报告。该报告将量化健康老龄化的基线指标;提供到2030年会员国认可的成果和影响指标的预测;并建议如何通过说明性、循证的干预措施在2020年至2030年期间增加影响，使各国能够改善老年人的内在能力和功能。2017年，世卫组织启动了健康老龄化的证据和证据国际联盟，由来自世卫组织所有区域的政策制定者、民间社会成员和研究人员组成。该联合会就健康老龄化问题开展研究和证据综合，并为编写基线报告开展工作。在这里，我们认为，这项工作和其他努力应该促进政策和科学证据之间的包容性对话，原因有几个。首先，各部委和国家机构决策者的观点和优先事项可以指导证据的提供。来自智利、中国、芬兰、加纳、印度、卡塔尔、新加坡和泰国的八项个案研究代表了世卫组织所有区域，目前正在审查利益攸关方如何利用证据为政策提供信息，作出方案决定，并确定可改善老年人生活的干预措施。这些国家案例研究将确定共同和独特的挑战，突出说明因具体情况而异的重要性，因为这些差异会影响政策的制定方式以及哪些因素会产生影响。例如，社区组织和社会创新可以在家庭和社区的保健和社会服务之间架起桥梁，4还可以传播和实施干预措施。第二，跟踪未来十年健康老龄化的进展情况应反映集体基准。澄清和测试实施和衡量健康老龄化的标准化方法将产生有意义的相关信息。世卫组织的国际功能、残疾和健康分类7是唯一一个以人为中心的规范性健康分类系统，也承认环境问题，为实际操作提供了共同基础。为验证健康老龄化的拟议组成部分和措施而进行的研究应让利益攸关方参与，并利用现有的最佳数据来源，无论是通过基于人口的研究、地理信息系统还是移动的设备收集的数据。例如，包括老年人在内的具有全国代表性的研究提供了大量数据，可用于分析不同人口中健康老龄化组成部分的结构和一段时间内的动态。证据综合可以为政策、指导和研究优先事项作出贡献。如何扩大有希望的试点项目，确保在不同环境中的成本效益，减少研究浪费，是需要改进的进一步领域。慢性病管理的临床试验证据很重要;然而，应优先研究以人为本的成果，利用老年人认为有意义的成果，如满足基本需求、学习和决策、行动能力、建立和维持关系以及对家庭作出贡献，社区或社会-所有这些都是功能能力的组成部分。12促进这些成果也将影响未来研究的设计，包括中低收入国家的创新。这些努力将有可能在“健康老龄化十年”期间及以后改善人们的生活。■
792 The World Health Organization’s (WHO’s) response to population ageing is to promote healthy ageing across the life-course. Healthy ageing is the process of developing and maintaining the functional ability that enables wellbeing in older age.1 Endorsed in 2016, WHO’s Global Strategy and Action Plan on Ageing and Health1 describes what governments, international agencies and other partners can do to meet the needs and aspirations of older individuals. The action plan calls for a transformation in policies and institutions to enable interlinked actions that embrace diversity and narrow health inequities.2 Multisectoral efforts that bring together stakeholders from public, private, civil society and nonprofit sectors,3 including older adults, are needed to adapt environments, so people can be and do what they value. A second action plan on ageing and health, a Decade of Healthy Ageing (2020–2030), is under preparation. In 2020, WHO will also issue a global baseline report. The report will quantify the baseline indicators of healthy ageing; provide projections of Member Stateendorsed outcome and impact indicators through 2030; and suggest ways to increase impact between 2020 and 2030 through illustrative, evidence-informed interventions that would enable countries to improve older adults’ intrinsic capacities and functional ability. In 2017, WHO launched the International Consortium on Metrics and Evidence for Healthy Ageing consisting of policy-makers, members of civil society and researchers from all WHO regions. This consortium conducts research and evidence synthesis on healthy ageing, with work progressing to inform the baseline report. Here, we argue that this work and other efforts should promote inclusive dialogue between policy and scientific evidence for several reasons. First, the perspective and priorities of policy-makers in ministries and national institutes can guide the provision of evidence. Eight case studies from Chile, China, Finland, Ghana, India, Qatar, Singapore and Thailand, representing all WHO regions, are currently examining how evidence is being used by stakeholders to inform policy, make programmatic decisions and identify interventions that can improve the lives of older persons. These national case studies will identify common and distinct challenges, highlighting the importance of context-specific variation that can influence how policies are developed and what contributes to impact. For example, community-based organizations and social innovations can bridge health and social services at home and in communities,4 and also disseminate and implement interventions.5 Initiatives engaging older adults as contributors, not only recipients, can empower older people and promote social cohesion. Second, tracking progress on healthy ageing over the coming decade should reflect collective benchmarking.6 Data and knowledge should be generated and shared jointly to help evaluating progress towards a common goal. Clarifying and testing standardized ways to operationalize and measure healthy ageing will lead to meaningful and relevant information. WHO’s International classification of functioning, disability and health,7 the only person-centred normative classification system of health that also recognizes context matters, provides a common basis for operationalization. Research to validate the proposed components of healthy ageing and measures should engage stakeholders and draw on the best available data sources, whether collected through population-based studies, geographic information systems or mobile devices. For example, nationally representative studies inclusive of older adults provide a wealth of data to analyse the structure of healthy ageing components in diverse populations and dynamics over time.8–11 Finally, evidence-informed decisions are required to increase impact. Evidence syntheses can be contributions to policy, guidance and research priorities. Ways to scale up promising pilot projects, ensure cost–effectiveness in diverse settings and reduce research waste, are further areas for improvement. Clinical trial evidence for chronic disease management is important; however, research on person-centred outcomes should be prioritized, using outcomes that older persons find meaningful, such as meeting basic needs, learning and making decisions, mobility, building and maintaining relationships, and contributing to families, communities or society – all of which are components of functional ability.12 Promoting these outcomes will also influence the design of future research, including innovations from lowand middle-income countries. These efforts will have the potential to improve peoples’ lives during the Decade of Healthy Ageing and beyond. ■