As the population of older people burgeons, many communities around the world are being forced to make the honest assessment of the ways they need to change to meet the unique needs of this growing population. One of the first and largest studies to address this challenge was launched just over a decade ago — an ambitious worldwide effort spurred by the World Health Organization (WHO).

From the outset, the initiative helped identify eight key areas that communities must address to become more age-friendly:

• outdoor spaces and buildings
• transportation
• housing
• social participation
• respect and social inclusion
• civic participation and employment
• communication and information, and
• community support and health services.

This served as a starting point for many local efforts worldwide, with ongoing and added programs and activities recorded at a dedicated website, Age Friendly World.

A Universal Plea: Better Healthcare

For most of the topics targeted, differing cultures, histories, and resources meant there were different cries for the type of help needed in different communities around the world. But when discussing community support and health services, seniors echoed a common cry: the need for affordable health care. Surprisingly, it was the cities in the most developed countries, with the greatest volume and range of community support and health services available, that also tallied the most complaints.

As one older resident from Portland, Oregon, who participated in the WHO initiative observed: “I’ve run into so many seniors that put off going to the doctor, and their health just deteriorates and deteriorates, because they don’t have the money.”

Additional needs identified included:

• Accessible care — well located, well publicized and easily accessible health services
• Wider ranging services — particularly geriatric clinics, adult daycare centers, and memory and rehabilitation care
• Disease prevention and health promotion — including preventive screening, guidance in nutrition and fitness, and mental health counseling
• Home care — help with grocery shopping and cooking as well as visits from professional care providers
• Residential care facilities — offering adequate and affordable care and accommodations, located close to services and residential areas
• Networks of community services — with particular attention to coordinating social and health services, or offering them in tandem in a centralized location
• Volunteers — particularly people to fill in the gaps in health and social services, to help with needs such as pet care and transportation, and
• Emergency support — geared to the needs of older people affected by natural disasters such as hurricanes, floods, and earthquakes.

The Hardest of Hard Problems

Many people said the problem of substandard health services for older people seemed intractable — especially since the organization, financing, and training of providers is simply deemed outside their influence or control.

Another roadblock frequently mentioned: care providers’ attitudes toward older people. Specific complaints included indifference, disrespect, and treating older people as a burden or a drain on resources.

“When they came to wash and change her, they treated her like a piece of furniture. No dignity. No respect,” said one WHO initiative participant, describing the home health aides’ treatment of his elderly wife.

Ideas bandied about to cure this ill included focused training for service providers to improve their communication skills and hone their sensitivity to working with the population of older people and the intergenerational approach of urging younger people to do volunteer work involving caring for older people.

None of the U.S. participants in the WHO initiative took on the tough topic of changing healthcare providers’ attitudes. But they could take some direction from the project initiated by the Age Friendly Island Programme working with Tower House Surgery, a health service practice in Ryde on the Isle of Wight, England’s second-most populated island. In consultation with a group of older patients, the group produced a toolkit, “Making Age Friendly GP Surgeries Work For You,” aimed at clinical staff and providing suggestions for simple steps to take to involve patients, staff, and local community groups in making the environment more age friendly.

The group also produced a short video highlighting the changes Tower House has made to become more age friendly and describing how patients have benefited from those changes. It ends on a hopeful note, with one of the patient participants, Joyce Lee, noting: “I personally feel that the best thing that has come from the group, from what we are doing, is that the patients are finding a voice.”

Cleveland Heeds the Call

Cleveland, a city in Ohio with a current population at the median age of 35, which is predicted to increase dramatically in the next few years, recently put into place two programs geared to making its community support and health services more age friendly.

• Cleveland Care Calls uses an automated telephone system to contact socially isolated seniors on days and at times they request. A recorded message then prompts them to press “1” if they are OK. If they don’t respond, a monitor calls the emergency contact they have specified. And if no contact is made, representatives from the city’s Department of Aging or Public Safety will visit the senior’s home to conduct a wellness check. About 200 residents receive the calls daily.
• The program also has a larger bank of phone numbers of about 37,000 older adults it can call to give information on how to proceed in the face of an emergency, such as extremely hot or cold temperatures.
• Thrive Where You Are, a joint effort between the Cleveland Department of Aging and Cleveland State University’s Physical and Occupational Therapy programs, produced an instructional exercise therapy video series for older adults. Each of the videos features Cleveland seniors demonstrating exercises focusing on muscle strengthening that can be done from a bed, chair, or standing. And each exercise focuses on progression of strength and skill, offering variations as the senior advances.