Implementation of community-based health checks and peer-to-peer support to promote functional ability for older people living in rural Zimbabwe

由于健康和卫生方面的进步，全世界人民的寿命比以往任何时候都长，撒哈拉以南非洲的预期寿命提高最多。在这些年的生活中，老年人想要健康和幸福，这是可以理解的，也就是“健康老龄化”。然而，目前许多非洲国家的医疗服务面临挑战，资源有限，正在努力为快速老龄化的人口提供服务，这意味着老年人更有可能生活在残疾和依赖中。世界卫生组织（世卫组织）将健康老龄化描述为老年人在他们居住的地方行走，视觉和听觉以及精神功能的能力。随着各国发展卫生服务以满足老龄化人口日益增长的需求，现在有机会积极规划提供整体医疗保健的创新方法，以帮助人们健康地度过老年。在撒哈拉以南非洲，大多数老年人退休后回到农村的家中（在津巴布韦称为Kumusha）。在这里，我们将开发一个“健康老龄化检查”，由当地农村社区的护士和治疗技术人员进行，老年人可以在那里进行评估，并提供实际的管理，以保持他们的健康。我们将与一系列利益相关者、医疗保健专家和老年人自己合作，为65岁及以上的人开发一种健康检查，我们将在津巴布韦进行测试。检查将评估例如，步行，平衡，营养，记忆，情绪，视力和听力。我们预计大多数老年人在几个方面都会有问题。当我们发现问题时，我们将提供建议，实用的解决方案，当地同行支持会议，并在需要时促进专家转诊。在整个研究过程中，我们将继续与当地社区密切合作，以了解观点，寻求建议，反馈进展，更重要的是，发展有效的同龄人支持小组，每个小组由一名非专业社区冠军领导，并由我们的团队在健康老龄化的特定方面进行培训。同龄人支助小组将把情况类似的老年人聚集在一起，使他们能够以小组为基础进行自我管理和活动（例如，小组练习、饮食小组练习、烹饪和营养小组练习、记忆练习）。我们将测试这些健康检查和解决方案的效果如何，例如，我们多久发现一次健康问题，多久提供一次解决方案，以及当我们在4个月后再次进行随访时，老年人多久接受一次建议。从理论上讲，津巴布韦的老年人可以免费获得公共医疗保健，但实际情况并非总是如此。因此，除了计算提供健康检查和护理的成本外，我们还将看看人们是否因为健康检查而经历额外的“自付”成本，如果是的话，原因是什么。在整个过程中，我们将收集病人、家属和医护人员对健康检查计划的详细反馈，以便我们可以改进和改善这一过程。最后，我们将与世卫组织沟通，开发一个“健康老龄化干预工具包”，以指导在社区环境中对老年人进行结构化、全面、以人为本的评估和管理，适合扩大到撒哈拉以南非洲的其他国家。津巴布韦是进行这项研究的理想地点，我们已与世卫组织非洲办事处商定，因为调查结果将反映该区域类似邻国的情况，这些国家的保健服务面临类似的挑战。此外，我们的研究团队与卫生部有着长期的工作关系，因此我们的研究结果可以直接为医疗保健解决方案提供信息。在四年内，我们将发展一支高技能和经验丰富的全球健康和老龄化研究团队，以确保在未来许多年对老年人的健康产生积极影响，并建立在这一领域开展进一步重要研究的能力。

Thanks to advances in health and sanitation, around the world people are living longer than ever before, with the greatest improvement in life expectancy happening in sub-Saharan Africa. In these added years of life, older people understandably want health and wellbeing, that is 'healthy ageing'. However, currently many African countries, with challenged healthcare services and limited resources, are struggling to provide for their rapidly ageing populations, meaning older people are more likely to be living with disability and dependence.The World Health Organization (WHO) describes healthy ageing as an older person's ability to walk, see and hear, and function mentally within the place they live. As countries develop health services to meet the growing needs of ageing populations, there is an opportunity now to proactively plan innovative ways of providing holistic healthcare to help people age well. In sub-Saharan Africa most older people retire to their rural homes (called Kumusha in Zimbabwe). Here we will develop a 'Healthy Ageing Check-up', run by nurses and therapy technicians in local rural communities, where older people can be assessed and offered practical management to maintain health as they age. We will work with a range of stakeholders, healthcare experts and older people themselves, to develop a health check-up for people aged 65 years and older, that we will test in Zimbabwe. The check-up will assess for example, walking, balance, nutrition, memory, mood, eyesight, and hearing. We expect most older people will have problems in several areas. When we find a problem we will offer advice, practical solutions, local peer support meetings and, if needed, facilitate specialist referral. We will continue to work closely with local communities throughout the research to understand perspectives, seek advice, feedback progress and importantly, develop effective peer support groups, each led by a lay community champion, trained in particular aspects of healthy ageing by our team. Peer support groups will bring together older people with similar conditions to enable group-based self-management and activities (e.g., group exercises, group work on diet, cooking and nutrition, memory exercises).We will test how well the roll-out of these health checks and the solutions work, for example how often we identify a health problem, how often we can offer a solution and, when we follow them up again after 4 months, how frequently the older person has taken up the recommendations. In theory, access to public healthcare is free for older people in Zimbabwe, although in practice this is not always the case. So, as well as calculating how much it costs to provide the health check-ups and care, we will see if people experience extra 'out-of-pocket' costs because of the health checks, and if so, the reasons for this. Throughout, we will gather detailed feedback from patients, families, and healthcare workers, about the health check-up programme, so that we can refine and improve the process. Finally, communicating with the WHO, we will develop a 'Healthy Ageing Intervention Toolkit' to guide the structured, comprehensive, person-centred assessment and management of older people in community settings, suitable for scale-up to other countries across sub-Saharan Africa.Zimbabwe is an ideal place to do this research, which we have agreed with WHO Africa, as the findings will reflect the situation in similar neighbouring countries in the region, where healthcare services face similar challenges. Plus, our research team have long-standing working relationships with the Ministry of Health, so that our research findings can directly inform healthcare solutions. Over the four years, we will grow a highly skilled and experienced global health and ageing research team to ensure positive impacts on older people's health for many years to come, and build capability to conduct further important research in this area.