International Council of Nurses [Fact Sheet

Nursing Matters fact sheets provide quick reference information and international perspectives from the nursing profession on current health and social issues.

ICN on Healthy Ageing:

A Public Health and Nursing Challenge
By 2020 world population will include more than 1 000 million people aged 60 and older; with more than 700 million living in developing countries

Nearly one million people cross the 60-year threshold every month. The 20^th century has seen a serious increase in the absolute and relative numbers of older people in developed and developing countries. Accordingly, nursing has sharpened its attention on the issue of healthy ageing.

Projections for population ageing into the first quarter of the 21^st century include:

By 2020, the Japanese population will be the oldest in the world, with 31% over 60 years of age, followed by Italy, Greece and Switzerland.

By 2020, five of the ten countries with the largest populations of older persons will be in the developing world: China, India, Indonesia, Brazil and Pakistan.

By 2020 the population of older persons from developing countries will rise by nearly 240% from the 1980 level, as a result of a rapid decline in fertility and an increase in life expectancy, due to the use of advanced technology and drugs.

Women outlive men in almost every country. They make up the majority of the oldest old and the elderly widowed, and are most frequently the carers of the worlds' older persons.

Impact on Health

Health of the older person is best measured in terms of function rather than pathology. Good health and successful ageing is defined in terms of the ability to function autonomously, within a given social setting. If socially and intellectually active, the older person may be considered healthy, even in the presence of chronic disease. Health care of the older person includes helping the individual maintain adaptive behaviour, promoting wellness, providing care during acute and long-term illness, and furnishing care and comfort in dying. The reality of an increasing population susceptible to a chronic or debilitating disease must however be faced.

The most common chronic conditions affecting older adults around the world are cardiovascular disease, cancer, diabetes, osteoarthritis, pulmonary disease, Alzheimer's disease and psychiatric disorders, most commonly depression and dementia.

By 2020, it is projected that three-quarters of all deaths in developing countries could be ageing-related. The largest share will be caused by non-communicable diseases, such as diseases of the circulatory system (CSDs), cancers and diabetes.

Hypertension rates and diabetes prevalence is rapidly increasing in the developing world. CSDs and cancer are the leading causes of mortality in Argentina, Cuba, Uruguay and parts of Asia.

In developing countries, all acute and chronic diseases of the older person are exacerbated by the presence of persistent poverty.

Among developing countries, malaria continues to be a major cause of impairment or disability.

Ophthalmic diseases such as cataracts, glaucoma, trachoma, and xerophthalmia underlie visual disabilities in the developing world. It is worth noting however, that in the United States alone, there are approximately 1.35 million cataract operations performed yearly.

In more developed regions, major chronic conditions affecting older persons are arthritis and other musculoskeletal diseases, sensory impairments (sight and hearing) and edutulism (toothlessness). It has been estimated that as many as 27% of people over 60 years have problems with incontinence.

Among the oldest old, the most frequently encountered conditions are dementia, stroke, and fracture of the neck of the femur.

Impact on Nursing

The increase in life expectancy results in a greater number of older persons in need of a wider range of health services, including health promotion, illness prevention, rehabilitation, acute/chronic care and palliative care. The goal of nursing care is to assist older persons in achieving optimal health, wellbeing, and quality of life, as determined by those receiving care or consistent with the values and known wishes of the individual.

Nursing care is recognised as the largest single component of the services required to care for the frail, sick and dying, while increasingly contributing to the maintenance of health and prevention of disease.

Nursing research indicates that older persons often describe health as a "state of mind". When discussing health they tend to emphasise psychological attributes, social relationships, and attitude toward life, rather than merely physical state.

The most important clinical issues in care of the older person were found to be :

confusional states, b) immobility, c) sensory loss, d) nutrition, e) loss/grief,

depression, g) incontinence, h) mental illness,i) substance abuse, j) death and dying.

Care of the older person is increasingly acknowledged as a nursing speciality requiring specific professional knowledge, skills and career structure.

Primary nursing has improved continuity and co-ordination of care during hospitalisation and facilitated discharge planning. Case management, where a single health care provider follows the same patient in repeated hospitalisations and assists or co-ordinates home care services, are also helpful to older patients.

Impact on Nurses

Nurses have a responsibility to maintain their level of competence, plan and deliver quality care, delegate tasks safely, and evaluate the services provided.

The increasing reports of abuse of elders in health care settings must be addressed by nurses. Raising awareness of the causes and consequences as well as developing/enforcing ethical standards of practice are crucial.

The average age of the nurse is increasing (43 years). The ageing of the nurse workforce needs to be considered when planning and managing human resources for the care of the older person.

An increasing percentage of nurse-entrepreneurs offer a range of services to the older person as patient advocates, care givers, counsellors and educators in addition to providing their clinical skills.