Health promotion and older people: the role of the general practitioner in Australia in promoting healthy ageing

OBJECTIVE: The Commonwealth Government's Enhanced Primary Care initiative supports measures to enhance the role of general practitioners (GPs) in promoting healthy ageing as part of a population health approach. This paper comments on how the health assessments can be conducted to best effect, to strengthen the role of GPs in primary care and to promote autonomy and independence in older people. METHOD: The relevant literature was collated to produce a review of public health and health promotion approaches and to ascertain the effectiveness of health promotion interventions for older people. A broad definition of health promotion including primary, secondary and tertiary prevention was adopted. RESULTS: The evidence base suggests there is scope for greater targeting of health promotion activities towards older people. The rationale for the Australian GP to assume a major health promotion role with their older patients is provided. Associated barriers and enablers are discussed. CONCLUSIONS: Prevention of disability is a key public health issue. The new MBS items may enable systematic evaluation of function and assist healthy ageing for all older people, including the frail aged. An increase in the preventive advice given to older patients has the potential to increase healthy behaviours and alter health outcomes. IMPLICATIONS: The annual health assessment items on the Medicare Benefits Schedule, by enabling the GP to focus on prevention and coordination of care, have the potential to improve the health, physical, psychological and social function of older Australians.     

Ageing of the Aboriginal and Torres Strait Islander population: numerical,structural, timing and spatial aspects

Objectives : To assess levels of numerical, structural, timing and spatial aspects of ageing of the Aboriginal and Torres Strait Islander population. Methods : Population projections for 15 Australian regions were created by a multi‐state cohort‐component model. Results : The older (45‐plus) population grew from 29,815 in 1986 to 167,259 in 2016. In the subsequent 30 years, we project growth to 448,785 people. Growth rates of the older population vary: from 200% in the 60–64‐year‐old group to 800% growth in the 85‐plus age group by mid‐century. This strong numerical ageing is reflected in a shift in structural ageing by about six percentage points. Selected areas outside of capital cities are structurally older than many cities. Numerical ageing is strongest in capital cities and New South Wales. Cohort flow is the primary driver of ageing. Conclusions : Numerical and structural ageing is projected to increase significantly to mid‐century with important spatial variations. Population ageing is largely irreversible. Implications for public health : High numerical growth in the older Aboriginal and Torres Strait Islander population poses implications for increased demand for a range of health and care services. Variations in spatial and timing aspects of ageing indicate demand will peak earlier in some geographical locations relative to others.     

Primary health care for older people: progress towards an integrated strategy?

The importance of providing integrated, holistic and cohesive primary care for older people has been increasingly emphasized in recent policy initiatives and directives in the UK. These have sometimes proved to be elusive goals, however, as an ageing population and rapidly changing health care environment have increased the pressures on the primary care team to keep pace with the growing level of need. As primary care faces a new set of challenges presented by the development of Primary Care Groups (PCGs), opportunities may be found to address older people's health needs in a more coordinated way. In South Buckinghamshire, a multi-agency group, Health for All (HFA), has been keen to develop collaborative and inter-agency working in older peoples' services and commissioned an evaluation to inform their work. This paper focuses on some of the key findings from the evaluation with reference to primary care. The purpose of the evaluation was to provide a snapshot of service provision for older people, identifying the level of access, availability of services and areas of unmet need. Twelve user groups were consulted and interviews held with 58 service representatives from health and social services agencies in the statutory and voluntary sectors. Primary care was considered in the wider context of service provision and key issues from the perspectives of providers and users were identified. A number of problems specific to primary care were identified which echo experiences in other parts of the country. However, also identified were common issues across a wide range of service provision, suggesting the need for coordinated strategies and more effective user participation. The HFA group is using the recommendations of the evaluation to assist in a priority setting exercise, which will inform the development of a strategy for older people in South Buckinghamshire.     

Support networks for Chinese older immigrants accessing English health and social care services: the concept of Bridge People

As Chinese immigrants in the United Kingdom age, they experience an increasing need to access health and care services. It has, however, been reported that older Chinese immigrants have difficulties in accessing these services. This study explored the experiences of this population in using health and care services and the strategies that they adopted to address their difficulties. A grounded theory method with a two‐staged research design was used. Stage 1 explored the participants’ experiences of ageing and use of health and social care services through focus group interviews. Stage 2 investigated the strategies individuals used to support access to and use of services through individual interviews. Forty‐four older Chinese people and 15 supporters participated in interviews during August 2011 and May 2013. These older Chinese immigrants were challenged in knowing about and in accessing services. Their difficulties were attributed to language barriers, lack of information and instrumental support, and emotional and cultural issues regarding use of health and care services. Their supporters facilitated access to services and acted as a bridge between the service and the user; therefore, they were given the title ‘Bridge People’. Bridge People have different backgrounds: family and friends, public sector workers and staff from community‐based Chinese organisations. The defining attributes of these supporters were: bilinguality, bicultural, multifunctionality and accessibility. There is no charge for this support; and the relationship between the Bridge Person and recipient involves trust and influence over decisions regarding use of health and care services. Bridge People should be recognised and identified by health, social care and housing services to promote engagement and use of services by older immigrant Chinese people.     

Investing in mental health and well-being: findings from the DataPrev project

A systematic review was conducted to determine the extent to which an economic case has been made in high-income countries for investment in interventions to promote mental health and well-being. We focused on areas of interest to the DataPrev project: early years and parenting interventions, actions set in schools and workplaces and measures targeted at older people. Economic evaluations had to have some focus on promotion of mental health and well-being and/or primary prevention of poor mental health through health-related means. Studies preventing exacerbations in existing mental health problems were excluded, with the exception of support for parents with mental health problems, which might indirectly affect the mental health of their children. Overall 47 studies were identified. There was considerable variability in their quality, with a variety of outcome measures and different perspectives: societal, public purse, employer or health system used, making policy comparisons difficult. Caution must therefore be exercised in interpreting results, but the case for investment in parenting and health visitor-related programmes appears most strong, especially when impacts beyond the health sector are taken into account. In the workplace an economic return on investment in a number of comprehensive workplace health promotion programmes and stress management projects (largely in the USA) was reported, while group-based exercise and psychosocial interventions are of potential benefit to older people. Many gaps remain; a key first step would be to make more use of the existence evidence base on effectiveness and model mid- to long-term costs and benefits of action in different contexts and settings.     

山西省百姓生殖健康促进工程试点地区育龄群众生殖健康状况基线调查

目的:了解山西省百姓生殖健康促进工程试点地区育龄群众生殖健康知识水平和生殖健康状况,以期提高项目工作的针对性和有效性。方法:2016年4-8月在山西省百姓生殖健康促进工程试点地区的基层计划生育妇幼服务机构,采用方便抽样,对15~65岁的人群进行问卷调查。结果:共调查964人,不同文化程度、年龄、户籍和人工流产史组生殖健康相关知识的正确率有统计学差异(均P0.05)。生殖健康相关知识的5个部分中,妇幼保健知识正确率较高(86.3%),性传播疾病/艾滋病知识正确率较低(56.0%)。在不同性别、年龄、文化程度以及人工流产史组生殖系统疾病患病率有统计学差异(均P0.05)。多因素logistic回归分析显示,调查人群中女性生殖系统疾病患病率与年龄和人工流产史有关(P0.001)。男性曾患生殖系统疾病与年龄有关(P0.05)。结论:年龄和文化程度偏低人群生殖健康知识较差,调查人群对性传播/艾滋病知识的了解相对较少。青少年、有人工流产史的女性生殖系统疾病患病率较高。提示基层服务机构应有针对性开展生殖健康咨询服务,提高教育覆盖面,改善育龄人群的生殖健康状况。     

General practitioner attitudes to discussing sexual health issues with older people

How health professionals perceive and manage later life sexual problems remains relatively unexplored and, in particular, little is known about the attitudes of GPs, who represent the first point of contact for most older people in the UK who experience sexual health concerns. This paper draws on qualitative data generated from in-depth interviews with 22 GPs working in demographically diverse primary care practices in Sheffield, UK. Analysis identified that GPs do not address sexual health proactively with older people and that, within primary care, sexual health is equated with younger people and not seen as a 'legitimate' topic for discussion with this age group. However, it was apparent that many beliefs held about the sexual attitudes and behaviours of older people were based on stereotyped views of ageing and sexuality, rather than personal experience of individual patients. The discussion considers the implications of these findings for primary care, particularly in relation to education and training.     

An international approach to community health care for older adults

Worldwide population ageing, concomitant increases in disability rates, and changes in family health care systems require an examination of current service delivery to optimize use of societal resources in the future. This article examines a community health care approach suggested by research conducted by the World Health Organization Kobe Centre for Health Development (WKC). The WKC approach, which uses a cross-national perspective, envisions a community health care system that integrates health and social services and spans health promotion, primary care, and long-term care. Prototypical approaches for organizing community health care include communal, marketplace, case management, and managed care. The ramifications of these approaches are examined from the perspectives of the older adult, the family, and formal service providers.     

“The people make it fun,the activities we do just make sure we turn up on time.” Factors influencing older adults’ participation in community‐based group programmes in Perth,Western Australia

Rapid ageing in western societies is placing increasing strain on health and social care services. In response, governments and health agencies have sought to promote healthy ageing through a range of interventions, many of which aim to enhance social engagement and participation among older people. Such interventions are based on evidence that being socially engaged through participation in various activities leads to better physical, mental and psychosocial health outcomes. The research reported here employed focus groups and individual interviews to address research aims: (a) identify enablers and barriers to participation in community‐based group activities among a sample of older people (n = 35, median age 71 years) living in a local government area in the northern suburbs of Perth, Western Australia, and (b) examine how these factors differ between those who regularly participate and those who do not. Our research highlighted four themes: Friendship and Function; Availability and Accessibility; Competing Responsibilities and Priorities; and Changing of the Guard. In particular, this research highlighted the importance of group activities in offering social support as a platform to develop friendships. The findings also indicated that opportunities for social interaction should be embedded in the structure of the group, beyond that which may occur incidentally during activities. This is important, given that while interest may motivate older people to join a group, a sense of belonging and connectedness generated through the group is more likely to maintain their attendance. Barriers included limited availability of local programmes, limited accessibility related to programme scheduling, and lack of programmes relevant to those who do not find traditional seniors’ centres appealing. Recommendations include incorporating social engagement as an outcome measure when evaluating the efficacy of programmes targeting older people, and encouraging local governments to work with seniors’ centres in developing activities attractive to a broader cohort of older people.     

Age-specific increases in health care costs

BACKGROUND: The escalating costs of health care raise questions about demographic, epidemiological and technological determinants and future projections. The objectives of this work are to describe the age pattern of health care costs, to analyse the age-specific cost changes and to project future health care costs in an ageing population. METHODS: Comprehensive cost-of-illness data for the whole Dutch population in 1988 and 1994 are compared by age and type of care. National data on all hospital admissions, nursing days and clinical interventions for the period 1988-1994 is used to describe trends in hospital care. Population forecasts are used to project the age distribution of future health care costs. RESULTS: The distribution of health care costs per capita depends strongly on age. The growth rate of per capita costs increases by age for acute care but decreases by age for long-term care. Both combined cause an average annual growth rate of 4.6%, nearly constant with age. CONCLUSIONS: Ageing will result in increasing health care demands and costs. Secular trends in acute and long-term care indicate major shifts in costs from younger to older people and from long-term to acute care.     

Dilemmas of modernization in primary health care in Western Samoa

This paper examines the historical development of rural women's associations (komiti tumāmā) in Western Samoa under New Zealand's colonial administration. These associations came to be the backbone of public health programmes and played a crucial role in preventive medicine at the village level: they embodied all the principles now subsumed under the rubric ‘primary health care’. The successful growth of a rural, self-help system of primary health care in Samoa resulted from the use of traditional institutions to promote new practices in sanitation and health care. The system rewarded and fostered village autonomy and enhanced the status of married women.This paper argues that a stagnation in community-based health programmes linked in part to an increasing unwillingness of rural women's associations to support such programmes has occurred most particularly in the past decade. It is proposed that this stagnation may be related to overall problems of modernization in the Western Samoan economy, professionalization and bureaucratization of the national health services, and the ritualization of certain key practices (such as the inspection of village sanitation) in preventive medicine by rural women.The consequences of the stagnation for rural people have been a greater dependence upon curative medical services, and a loss of clearly defined roles for women's institutions in primary health care. The historical drift has been away from rather than towards the PHC model as espoused today by the World Health Organization and as initiated by the New Zealand administration in colonial times.     

Women's health: consumer views for planning local health promotion and health care priorities

Abstract: A random door knock survey was conducted in five metropolitan postcode areas with a high proportion of low-income households to establish: 1. the health problems experienced by women, 2. the problems with which women would have liked more help, and 3. women's perceptions of how their health care experiences might have been improved. In all, 214 women were interviewed. Across all age groups the most common problems were tiredness, premenstrual syndrome, stress, being overweight and disturbed sleep. Premenstrual syndrome, tiredness and arthritis were the most commonly experienced problems among younger, middle-aged and older women respectively. In general, women were satisfied with the help available to them for their health problems, but one in five would have liked more help to cope with stress, and one in six said they would like help to address the issue of quality of medical care. In relation to health care services, suggestions for improvement included the provision of better health information from doctors and other health care professionals, and more opportunities for counselling and self-help. The project findings will be used to influence the development of local policies and services, and will form the focus for local women's health promotion programs.     

Evidence to support church-based health promotion programmes for African Canadians at risk for cardiovascular disease

High quality management of cardiovascular disease is a critical health issue for people of African descent as this group is more likely than the general population to have greater coexisting cardiovascular comorbidities. The higher than average rates of cardiovascular conditions among Black populations are a cause for concern. In an effort to combat the disproportionate number of African Americans experiencing cardiovascular conditions a significant number of churches within the African American community have initiated health promotion programmes and/or services. Health organisations and agencies in the United States are keen to support and encourage these programmes for cardiovascular disease risk populations (i.e. African Americans and other minority groups, such as the Hispanic community). Indeed these health organisations and agencies recognise the need to promote healthier habits among African Americans and other minority groups as statistics continue to show health disparities among these populations within the US health care system. This paper attempts to encourage Canadian health agencies, organizations and practitioners to support similar CBHPPs initiatives for the African Canadian population. The historical significance of the church in Black Canadian communities is also examined.     

Mental health. Respect your elders

Mental health services for older people tend to be neglected by policy in favour of general adult mental health services. Inadequate staffing, lack of capacity and insufficient intermediate care are all contributing factors. Salford and Trafford trust now has accredited training for primary care nurses in the identification and initial management of mental health problems in older people.     

Forschung zur Versorgung im höheren Lebensalter

Three examples serve to highlight challenges for health care that stem from population ageing and the health situation of the elderly. The first challenge is to develop and evaluate prevention and health promotion programmes for the elderly. Two promising interventions are outlined: 'preventive home visits' and 'active health promotion in old age'. The second challenge is to improve the coordination of health and social care measures. Case management is presented as one adequate approach in this regard. The third challenge stems from the increasing prevalence of age-specific diseases. In terms of dementia it is pointed out that it is important to improve early diagnosis and to integrate self-help groups and counselling services into therapy.     

Vouchers for primary healthcare services in an ageing world? The perspectives of elderly voucher recipients in Hong Kong

Considering the ageing population in economically advanced regions across the world, measures are necessary to enhance the health of the older population as well as contain public healthcare spending. Hong Kong implements the Elderly Health Care Voucher Scheme (EHCVS), providing older people aged 65 or above an annual subsidy of visiting private healthcare service providers for chronic disease prevention and management. The services also aim at reallocating demand from the public to private sector as well as improve quality of services. This qualitative study explored the experiences of EHCVS recipients (n = 55, aged 61–94) with eight focus group interviews in Hong Kong in the year 2016. Convenience sampling was used. Research questions were: (1) Why do older people choose not to use EHCVS for preventive as well as disease management services among older people in Hong Kong? (2) What are the barriers to reallocating demand from the public to private sector? (3) In what ways did EHCVS improve the quality of primary care services for older people? Using a deductive and inductive approach, eight qualitative themes were identified. Findings suggested that the non‐targeted services and inadequate knowledge on EHCVS deterred older people from using the vouchers for disease management and prevention. The relatively expensive private services, lack of trust in the private sector, low public clinic fees and good services quality of the public sector, together with inadequate private practitioners in the healthcare market were barriers that hinder demand reallocation. Nevertheless, the quality of primary care services had been improved after the implementation of EHCVS with shortened wait times and opportunities to discuss health‐related issues with private practitioners. Findings were discussed with practice, policy and research implications.     

Satisfaction with health and community services among homeless and formerly homeless individuals in Quebec,Canada

User satisfaction is a crucial quality indicator in health service provision. Few studies have measured user satisfaction among homeless and formerly homeless individuals, despite the high prevalence of mental health disorders (MHD) in this population. The purpose of this study was to assess overall satisfaction among 455 homeless and formerly homeless individuals who were receiving health and community services, and to identify factors associated with user satisfaction. Data collection occurred between January and September 2017. Study participants were 18 years old or over, with experience of homelessness in the current or recent past. They completed a questionnaire eliciting socio‐demographic information, and data on residential history, service use and satisfaction and health profiles. Multivariate linear analysis was performed on overall satisfaction with health and community services in the previous 12 months. Independent variables were organised as predisposing, enabling and needs factors based on the Gelberg–Andersen Behavioral Model. The mean satisfaction score was 4.11 (minimum: 1; maximum: 5). Variables associated with greater user satisfaction included: older age, residence in permanent housing, common MHD (e.g., depression, anxiety), having a family physician, having a case manager, strong social network, good quality of life and, marginally, male sex and having substance use disorders (SUD). By contrast, frequent users of public ambulatory health services were the most dissatisfied. User satisfaction was more strongly associated with enabling factors. Strategies for improving satisfaction include: promoting more tailored primary care programmes (including family physician) adapted to the needs of this population, better integrating primary care with specialised services including SUD integrated treatment and enhancing continuity of care through the reinforcement of case management services. Further efforts aimed at increasing access to permanent housing with supports, and eliciting more active involvement by relatives and friends may also improve user satisfaction with services, and reduce unnecessary service use.     

流动育龄妇女母婴保健知识调查结果分析与健康促进策略

目的:掌握深圳市流动人口母婴保健相关知识的知晓率,并根据调查结果科学评估与制定全市降低孕产妇死亡率、消除新生儿破伤风专项行动计划(简称《降消项目》)与健康促进策略,最终促进流动孕产妇能自觉自愿接受孕产期保健服务与住院分娩,有效地降低孕产妇死亡率、消除新生儿破伤风。方法:采用整群抽样的方法,在深圳市内流动人口较密集的城乡交汇区向流动人口育龄妇女随机发放母婴保健相关知识调查问卷共256份,分别以户籍、年龄、职业、文化程度、家庭经济状况等为分析项目,运用SPSS 11.0对资料进行统计分析。结果:流动育龄妇女母婴保健相关知识知晓率较低,母婴保健知识知晓率与文化程度有直接的关系,文化程度越高,知识答对率越高,经统计学处理,有显著性意义(P<0.05);与年龄、职业、家庭经济状况无显著性差异。结论:文化程度是影响深圳市流动人口孕产妇自我保健意识的关键因素。提示加大对文化程度较低的流动人口孕产妇健康教育力度,提高这部分人群母婴保健知识知晓率,最终促进这部份人群自觉自愿住院分娩,是突破深圳市《降消项目》健康促进的关键和重点措施。     

What prevents older people from seeking treatment for urinary incontinence? A qualitative exploration of barriers to the use of community continence services

BACKGROUND: Urinary incontinence is a significant health problem for older people. Many people with incontinence do not seek services. Simple and effective treatments exist in primary care. OBJECTIVES: Our aim was to explore reasons why older people living in the community do not present for help with problems of urinary incontinence and to identify ways in which they may be assisted to access continence services. METHODS: In-depth interviews lasting an average of 1 h were conducted with 20 people aged over 65 years living in the community, purposively selected from a sample of patients who volunteered to be interviewed. RESULTS: Older people described ageing as a natural, degenerative process and had reduced health expectations. Urinary incontinence was commonly viewed as an inevitable aspect of ageing and, as such, something to be accepted and managed independently. Shame and embarrassment combined with generational differences in attitudes to disclosure about personal matters also prevented people from seeking advice. Relatively successful strategies to manage incontinence enabled people to contain their symptoms, although this was at a social, psychological and, in some cases, health cost. Older people in this sample had considerable co-morbidity, in many cases resulting in mobility problems. Despite regular contact with primary care professionals, they had seldom disclosed their urinary incontinence. CONCLUSION: A combination of personal attitudes and practical barriers prevent older people from seeking help for urinary incontinence. It is possible that older people would be more likely to seek help if asked specifically about urinary leakage by primary health care professionals.