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Healthy Ageing Strategy
E noho ora ana te hunga pakeke, e noho pai ana
i ngā tau o te kaumā tuatanga tae noa atu ki ngā
tau whakamutunga o te rangatira i roto i nga ringa
manaaki, ringa atawhai o te hā pori.
Older people live well, age well and have a respectful end of life in age-
friendly communities.
Citation: Associate Minister of Health. 2016.
Healthy Ageing Strategy. Wellington: Ministry of Health.
Published in December 2016
by the Ministry of Health
PO Box 5013, Wellington 6140, New Zealand
ISBN 978-0-947515-84-3 (print)
ISBN 978-0-947515-85-0 (online)
HP 6514
This document is available at health.govt.nz
This work is licensed under the Creative Commons Attribution 4.0 International licence. In
essence, you are free to: share, ie, copy and redistribute the material in any medium or format;
adapt, ie, remix, transform and build upon the material. You must give appropriate credit,
provide a link to the licence and indicate if changes were made.
Foreword
Associate Minister of Health
Older New Zealanders are a large and growing
proportion of our population – by 2036, one in
four of us will be aged 65 years or older. We all
deserve our best support to age well, live healthy,
independent lives and to have a respectful end
of life.
I commissioned this revision of the Government
Health of Older People Strategy to help is committed to the goals of positive
ensure that the resources of our health ageing, where older people age
system remain focused on providing well and are healthy, connected,
that support and empowering people. independent and respected.
It sets the direction for the health
At its heart, the Healthy Ageing
sector and outlines the actions needed
Strategy is about people. Its priority
to improve the health outcomes and
is adding life to years not just years
independence of older people in a
to life. People age in different ways,
sustainable way.
and our population is diverse. We
I have rebranded it the Healthy Ageing must recognise the range of ways
Strategy for several reasons. We are older people access and interact with
all ageing, in different ways, and don’t services.
necessarily become ‘old’ when we
We need a multi-faceted and
reach the age of 65. Healthy ageing
coordinated approach to improve
recognises the diversity of older people,
the health and wellbeing of our older
and ultimately seeks to maximise health
people, particularly those living with
and wellbeing into and throughout
long-term conditions, with high and
people’s older years.
complex needs or in population groups
The Healthy Ageing Strategy is aligned that are experiencing poorer outcomes
with the wider New Zealand Health from our health system. Our health
Strategy. It also has strong links the system also needs to meet the health
Positive Ageing Strategy. Older people and support needs of an increasingly
make a significant contribution to and ethnically diverse population.
have an integral role in our society. The
Healthy Ageing Strategy iii
This will require the health and social Many people and organisations have
sectors to work collaboratively and for been involved in developing this
everyone in New Zealand to recognise Strategy. This reflects the wide variety
the important role that family and of those who care about and influence
whānau carers play in supporting older people’s health and wellbeing.
our older people in their homes and I would like to thank everyone who has
communities. contributed.
As well as enabling and supporting I would especially like to acknowledge
older people to age well, this Strategy the input of older people and their
focuses on ensuring older people have family and whānau carers. Your
a respectful end of life. Older people contribution has been particularly
need to feel safe and supported to important in helping shape the Strategy
openly discuss and plan their end-of- and the services it provides.
life care. The health system needs to be
Hon Peseta Sam Lotu-Iiga
responsive to older people’s wishes.
Associate Minister of Health
iv Healthy Ageing Strategy
Foreword
Director-General of Health
With the release of the New Zealand Health
Strategy, now is the right time to set out a refreshed
strategy for the health of older New Zealanders –
the Healthy Ageing Strategy.
Its predecessor, the Health of Older peoples’ health
People Strategy, was launched in 2002. and wellbeing in
The 2002 strategy delivered many later life.
successes, including greater choice in
The Healthy Ageing Strategy has been
long-term health care services. We can
written with this goal in mind. It has a
all be proud of that.
strong focus on prevention, wellness
However, the social and demographic and support for independence. It also
picture in our country has changed recognises the importance of family,
over the past 14 years. In 2002, whānau and community in older
when the current strategy was people’s lives. It gives greater priority
published, those aged over 65 made to equity and supporting the most
up 11.5 percent of the New Zealand vulnerable, including those with high
population. That amount has now and complex needs and in the final
climbed to 15 percent and is set to stages of life. In addition, it signals the
climb further. This has significant need for government agencies, health
implications for policy, planning, service care providers and all who seek to
design and delivery. make a positive difference to health
and wellbeing to work together. Better
We must ensure our health system
integrating health and social responses
provides the care, support and treatment
will help us to be more responsive to
that older New Zealanders need and that
New Zealanders’ needs and choices.
level of care is sustainable. We want a
health system that works for every older The five New Zealand Health Strategy
New Zealander. themes support the Healthy Ageing
Strategy actions. These themes –
Achieving this means taking into
people powered, closer to home,
account all the factors that impact on
value and high performance, one
Healthy Ageing Strategy v
team and smart system – articulate were involved in creating this strategy:
the wider system in which the goals from individuals to families and whānau,
of the Healthy Ageing Strategy can be carers, health professionals, service
achieved. providers, government and non-
governmental organisations. We all have
I believe this strategy provides us with
an ongoing role to play in helping every
a clear focus and vision for where we
older New Zealander live well, get well
need to head. As with the New Zealand
and stay well.
Health Strategy, the Ministry of Health
will provide the leadership needed I’d like to thank everyone who has
to help all the organisations involved contributed to the Healthy Ageing
play their part in the required actions, Strategy. I look forward to working with
changes and focus. you as we deliver it.
Leadership in this context is not about Chai Chuah
being in charge or having all the Director-General of Health
answers. Many people and organisations
vi Healthy Ageing Strategy
Contents
Foreword Associate Minister of Health iii
Foreword Director-General of Health v
Acknowledgements viii
Why a Healthy Ageing Strategy 1
Strategic context 4
Taking a life-course approach 8
Challenges and opportunities 10
Vision and priorities for action 16
Ageing well – Te pai o ngātau o te kaumātuatanga 18
Acute and restorative care – Ngā tuāhuatanga manaaki, whakaora i te
hunga māuiui 25
Living well with long-term conditions – E noho ora ana i roto i ngā
mauiuitanga o te tinana 32
Support for people with high and complex needs – He tautoko i te hunga
pakeke he uaua, he maha hoki o rātau taumahatanga 37
Respectful end of life – Te mate rangatira i ngā tau whakamutunga o te
hunga pakeke 41
Turning the Strategy into action 45
Action plan 48
References 68
Healthy Ageing Strategy vii
Acknowledgements
The Ministry of Health has received • Dr Michal Boyd, Senior Lecturer,
valuable input from over 200 written School of Nursing and Department
submissions on the draft Health of of Geriatric Medicine, University of
Older People Strategy (now Healthy Auckland
Ageing Strategy) by the closing date • Stephanie Clare, Chief Executive,
of 7 September 2016. Five regional Age Concern New Zealand
workshops also collected input from • John Collyns, Executive Director,
hundreds of participants around the Retirement Villages Association
country, including researchers, district
• Hamish Crooks, Chief Executive,
health boards, clinicians, primary
Pacific Homecare
health and other non-governmental
• Dr Ken Greer, Clinical Advisor,
organisations, older people, carers, and
Primary and Integrated Care, Capital
aged-care, Māori and Pacific providers.
and Coast District Health Board
Earlier rounds of engagement • Vui Mark Goshe, Chief Executive,
workshops had provided a high Vaka Tautua
degree of confidence around the • Julie Haggie, Chief Executive, Home
overall approach and themes of the and Community Health Association
draft Strategy. The public consultation
• Sir Matiu Rei, Director, Ora Toa
process on the draft focussed largely on
• Robyn Scott, immediate past Chief
identifying whether the right actions had
Executive, Age Concern New
been developed and given priority. Over
Zealand
2000 people were involved in those
Strategy development workshops. • Simon Wallace, Chief Executive,
New Zealand Aged Care Association
The Ministry would like to particularly • Sarah Clark, Director, Office for
acknowledge the contribution of the Seniors (ex-officio member)
expert advisory group:
• Blair McCarthy, Acting Director,
• Dr Janice Wilson, Chief Executive, Office for Seniors (ex-officio
Health, Quality and Safety member).
Commission (Chair)
viii Healthy Ageing Strategy
Why a Healthy Ageing
Strategy
Everyone is ageing, and everyone wants to age well. That New
Zealanders are living longer than ever before is a major success story,
and many older New Zealanders are healthy, active and resilient.
Healthy Ageing Strategy 1
Remaining in good health, ageing well ‘old’ at any particular age or in the same
and being able and supported to live way. Ageing is only partially associated
well with long-term conditions, however with chronological ageing and it does
complex, is critical to enable older not ‘start’ at 65. Some older people
people to continue participating and remain independent and competent,
feeling valued (two important factors for both physically and mentally,
health and wellbeing). throughout their older years. Some
enter their older years with long-term or
We have a good base to build on, with
chronic health conditions or disabilities,
many significant improvements to the
and their needs become more complex
health and disability support system for
as they age. Others develop disabilities
older people since the release of the
and become dependent as they age,
2002 Health of Older People Strategy.
due to cognitive and physical decline,
For example, we are supporting more
and conditions such as dementia.
people than ever with long-term health
conditions and disabilities to remain in We need to ensure our system is truly
their homes for longer. We also provide people-centred and appropriate to New
more consistent and comprehensive Zealand’s growing ethnic diversity.
needs assessments, greater choice and
improvements in the quality of home
Our system and services must
and community services and aged
aim to keep people in good
residential care. Moreover, access to
health for longer, recognising
elective surgery has improved, as have
that older people have
discharge practices.
different needs at different
We want to maintain the positive times.
changes we’ve seen over the last
14 years and improve on them in People with the highest needs may be
the current context. Our operating those who have the fewest resources
environment and the strategic context and the least capacity to address those
in which we work have changed. We needs.
need a new strategy that expands on This document sets out a strategy for
the strengths of the past and sets the the health and wellbeing of older people
direction for improved performance and for the next 10 years.
outcomes across the board.
It is the result of extensive engagement
The Healthy Ageing Strategy (the with older people, their families, whānau
Strategy) is for older people, their and carers, aged-care providers, health
families and their communities. Older care professionals, professional bodies,
people are by no means a homogenous researchers, Māori and Pacific peoples
population group. We don’t become and their service providers, government
2 Healthy Ageing Strategyagencies, district health boards communication and empathy in
(DHBs), primary health organisations health care, and for providers to help
(PHOs) and other non-governmental older people articulate and listen to
organisations (NGOs) that represent what is important to those people in
and support older people. their care
• a call for more flexible services that
Hearing the voice of older people was
respond to people’s individual needs
especially important in developing
and diversity, but where people
this strategy, and many older people
can expect to have the same level
provided feedback and were involved
of access wherever they are in the
in forming the Strategy’s actions.
country
They came from a wide variety of
backgrounds and offered many different • a clear appreciation of the quality of
perspectives, aspirations and ideas health care
about ageing. • an expectation for a highly
integrated, well-coordinated,
While it is important not to generalise, responsive health system
their feedback covered some notable,
• acknowledgement of the tangible
consistent themes, including:
benefits of technology, provided no
• the desire to be connected and one is excluded or left behind.
respected
There are three parts to this document.
• a need to reduce barriers to
The first part introduces the strategy
participation in society, to keep
and the context in which it exists.
active physically, mentally and
The second section presents the
socially
overarching direction for the health
• enthusiasm for age-friendly
system for the next ten years with
communities
respect to the health and wellbeing of
• a keenness to be empowered to take older people. The third section is the
responsibility for their health, and to action plan: specific actions we intend
develop the skills to do so to take to address the health and
• the importance of good wellbeing requirements for older people
and achieve the desired outcomes.
Healthy Ageing Strategy 3Strategic context The New Zealand Health Strategy provides the overarching framework and directions for our country’s health system. 4 Healthy Ageing Strategy
The New Zealand Health Strategy The Disability Strategy was informed
describes the future we want, identifies by the United Nations Convention on
the cultures and values that underpin the Rights of Persons with Disabilities,
this future and sets out five strategic ratified in 2008. The Healthy Ageing
themes for changes we can make that Strategy is consistent with the articles
will take us toward its vision. of the Convention.
All New Zealanders live well, stay Positive Ageing Strategy
well, get well, in a system that is
Government has a long-standing
people-powered, provides services
commitment to the vision and principles
closer to home, is designed for
of the cross-government New Zealand
value and high performance, and
Positive Ageing Strategy 2001, as
works as one team in a smart
reiterated in 2013 in Older New
system.
Zealanders – Healthy, Independent,
New Zealand Health Strategy vision
Connected and Respected.
The New Zealand Health Strategy Older New Zealanders: healthy,
provides the building blocks for this independent, connected and
Healthy Ageing Strategy. Together they respected.
define how we will maintain and improve
Cross-government New Zealand Positive
healthy ageing and independence,
Ageing Strategy 2001
regardless of people’s health status, and
provide better support for older people
Government agencies are working with
with high and complex needs and at the
local government, towards a ‘vision of a
end of their lives.
society where people can age positively
and where older people are highly
New Zealand Disability valued and recognised as an integral
Strategy part of families and communities’.
The New Zealand Disability Strategy
also informs the Healthy Ageing Treaty of Waitangi and He
Strategy. It presents a long-term plan Korowai Oranga
for:
The health of older Māori is a priority for
A society that highly values the this strategy. We recognise and respect
lives of people with disabilities the special relationship between Māori
and continually enhances their full and the Crown through the Treaty of
participation. Waitangi. In the health and disability
New Zealand Disability Strategy vision
Healthy Ageing Strategy 5sector, this involves working to the ‘Ala Mo’ui – Pathways to
principles of: Pacific Health and Wellbeing
• partnership: working with iwi, hapū, 2014–2018
whānau and Māori communities to
’Ala Mo’ui: Pathways to Pacific
develop strategies for Māori health
Health and Wellbeing 2014–2018 is
gain and appropriate health and
the Government’s national plan for
disability services
improving health outcomes for Pacific
• participation: involving Māori at all
peoples, families and communities. ‘Ala
levels of the health and disability
Mo’ui has four priority outcome areas:
sector, including in decision-making,
• systems and services meet the
planning, development and delivery
needs of Pacific peoples
of health and disability services
• more services are delivered locally in
• protection: working to ensure Māori
the community and in primary care
have at least the same level of health
as non-Māori, and safeguarding • Pacific peoples are better supported
Māori cultural concepts, values and to be healthy
practices. • Pacific peoples experience improved
broader determinants of health.
Pae ora: Healthy Futures
for Māori Other national plans and
wai ora, whānau ora, initiatives
mauri ora.
Other specific national strategies,
action plans and work programmes
Our approach to improving Māori health
influence the health of older people
is guided by He Korowai Oranga, Māori
and guide programmes and services
Health Strategy. He Korowai Oranga
on ways to meet their needs. These
has an overarching goal of pae ora,
include:
which translates to healthy futures
for Māori. Pae ora comprises wai ora • New Zealand Framework for
(healthy environments), whānau ora Dementia Care
(healthy families) and mauri ora (healthy • Improving the Lives of People with
individuals). Pae ora encourages Dementia
everyone in the health and disability • Primary Health Care Strategy
sector to work collaboratively, and to • Living Well with Diabetes: A plan for
work across sectors to achieve a wider people at high risk of or living with
vision of good health for everybody. diabetes 2015–2020
Implementation of He Korowai Oranga • The New Zealand Carers’ Strategy
across the health system recognises and Action Plan 2014–2018
and respects the principles of the
Treaty.
6 Healthy Ageing Strategy• Pharmacy Action Plan 2016–2020 Organization (WHO) Global Strategy on
• Rising to the Challenge: The Mental Ageing and Health 2016–2020, a
Health and Addiction Service five-year strategy for action to maximise
Development Plan 2012–2017 functional ability for all, and build the
• Review of Adult Palliative Care evidence and partnerships for a Decade
Services. of Healthy Ageing from 2020 to 2030.
The Global Strategy’s five strategic
The Healthy Ageing Strategy objectives are:
incorporates several aspects of these
• commitment to action on healthy
population, service improvement and
ageing in every country
condition-related strategies and work
• developing age-friendly environments
programmes.
• aligning health systems to the needs
of older populations
Global Strategy on Ageing
• developing sustainable and equitable
and Health systems for providing long-term care
Internationally, New Zealand is (home, communities, institutions)
a signatory to the World Health • improving measurement, monitoring
and research on healthy ageing.
Healthy Ageing Strategy 7Taking a life-course approach How well we age is influenced by our genetics, our upbringing, how healthily we live in our younger years and throughout our adult life and our exposure to health risks including poor housing, workplace discrimination and family violence. 8 Healthy Ageing Strategy
Also highly influential are our physical ageing’ does not refer to the absence of
and mental capabilities; our access disease or physical or mental ill health.
to resources and opportunities; WHO defines healthy ageing as ‘the
our resilience including in the face process of developing and maintaining
of adversity; our relationships; our the functional ability that enables
personal circumstances, including our wellbeing in older age.’
occupation, level of wealth, educational
Initiatives for older people that take
attainment and gender; our potential for
a life course approach, promoting
personal growth; and our cultures and
‘healthy ageing’, focus on building
sense of identity, security, value and
and maintaining people’s physical
wellbeing.
and mental function and capacity,
This strategy applies a life-course maintaining independence and
approach to achieving the aim of preventing and delaying disease and
healthy ageing. It recognises that we the onset of disability. Such initiatives
age in different ways and have different aim to maintain quality of life for older
needs at different times, and that our people who live with some degree of
health is affected by our environment. illness or disability requiring short or
The approach involves enhancing long-term care. They enable disabled
growth and development, preventing people to do the things that are
disease and ensuring every person important to them, enhancing their
functions to the highest capacity participation, social connection and
possible throughout their life. ‘Healthy appropriate care and ensuring their
dignity in later years.
Figure 1: A life-course framework for healthy ageing
High and stable Declining
Significant loss
Functional
ability
Intrinsic
Capacity
Prevent chronic conditions
Health services Reverse or slow Manage
or ensure early detection
declines in capacity advanced
and control
chronic conditions
Support capacity-
enhancing
Long-term care Ensure a
behaviours
dignified late life
Promote capacity-enhancing behaviours
Environments Remove barriers to participation,
compensate for loss of capacity
Source: WHO 2015
Healthy Ageing Strategy 9Challenges and opportunities New Zealand’s population is ageing. There will be a substantial increase in the number of older people over the next decade. 10 Healthy Ageing Strategy
This older population, and our Currently, over one in six older people
communities, will also become more are living with three or more long-term
ethnically diverse. The Māori population conditions. Based on existing trends,
of people aged 65 and older is projected an increasingly older population will
to increase by 79 percent in the 10 years mean steadily increasing health care
to 2026. The older Pacific population is needs. As a population group, older
expected to increase by 63 percent, and people have much higher rates of long-
older Asian population by 125 percent in term chronic health conditions, and
this same period. disabilities that require support on a
daily or regular basis.
The changing population has
major policy, funding and planning We are living longer, but the age to
implications. We need to plan well which we are likely to live in good health
to make sure we are well equipped and without disability is not increasing
nationally, regionally, economically at the same rate as life expectancy. At
and socially. We need to have the right the age of 65, people can expect to
infrastructure in place to keep people in live half of their remaining lives either
good health and provide for those who free of disability or with functional
are not. limitations that can be managed without
assistance.
Figure 2: Population projections by age group
with 10 year percent change This is not the same for
Population (million) Age all population groups. In
90+
5.5
85–90
a comparison of Māori
45%
5 40% 75–84 and non-Māori males and
57% females, Māori males aged
4.5 65–74
31% 65 can expect the shortest
4 55–64
remaining time of living
13%
without disability or long-
3.5
8% 45–54 term illness (5.5 years on
3 average) and the highest
2.5 proportion of remaining time
14%
25–44 lived with disability requiring
2
support (64 percent).
1.5
People with intellectual
1
1%
disabilities have some of the
0–24
.5 poorest health outcomes
and can develop dementia
0
2015/16 2025/26 2035/36 at a younger age.
Year
Source: Statistics New Zealand, 2016
Healthy Ageing Strategy 11Figure 3: Māori and non-Māori life expectancy for a whole-of-system approach
at age 65
to achieving, balancing and
85 measuring improved health and
equity for all populations, best
value for public health system
80 resources and improved quality,
80.4 82.5 84.1 86.6 safety and experience of care.
To achieve equity, we need to
75
understand and remove the
barriers that prevent groups from
experiencing equitable health
70
outcomes, and build on the
70.5 74.4 75.6 75.7 factors that enable equity. We
need to work together with other
65 sectors to address a range of
Māori Māori non-Māori non-Māori
males females males females barriers. The existing barriers we
know about are infrastructural,
Years with disability Years without disability
financial and physical. Others can
Source: Ministry of Health, 2013 be difficult to articulate or identify.
Figure 4: New Zealand Triple Aim
Health inequities Framework
re
We need to continue our efforts to
Im
ca
pro
of
reduce inequities in health, so that all
ve
ce
dh
population groups can enjoy good
en
ea
eri
health and participate fully in family
lth
xp
de
an
and community life. In this respect, the
de
Po
an
al
du
pu
qu
ty
Ministry of Health (the Ministry) focuses
afe
ivi
lat
ity
Quality
Ind
specifically on the health of Māori,
s
ion
for
ty,
Improvement
all
ali
Pacific peoples, migrant and refugee
qu
po
communities, people with disabilities,
ed
pu
System
v
lat
pro
people with long-term mental health
ion
Im
s
conditions or addictions and people with Best value for public health system resources
low incomes, who experience persistent
We need to better understand how well
inequities.
our services are working for different
Achieving equity is a core component population groups, and why problems
of the ‘value and high performance’ arise. This has implications for the
theme of the New Zealand Health way that the health sector conducts
Strategy. This is underpinned by the research, collects data and evaluates
New Zealand Triple Aim Framework the effectiveness of services.
12 Healthy Ageing StrategyStaying healthy and services. These approaches provide
independent in older age significant opportunities for improving
the health of New Zealanders in general
We have an opportunity to reinforce
and older New Zealanders in particular.
and accelerate the positive trends we
One example of a social investment
have seen in recent years. By focusing
approach might be a concerted effort
on preventing illness and by making it
across government to reduce social
easier to choose healthy options (like
isolation and loneliness, which we
eating healthy food, not drinking alcohol
know have a strong relationship
or only drinking at low-risk levels, and
with poor mental and physical
undertaking regular physical activity),
health outcomes and with increased
we can help people to avoid developing
problematic alcohol use.
long-term health conditions or slow
the development of those conditions.
Most importantly, we can do this by Workforce development
providing universal health services
The health system faces some
and public health initiatives that cover
significant workforce challenges. The
the whole population and by having
health of older people workforce is
services in place to intervene early and
itself ageing and some key workforce
help people to return to good health
groups have experienced recruitment
and remain independent. As part of this,
difficulties. For example, forecasts show
we need tailored approaches for some
that we will have trouble maintaining the
individuals and population groups, to
necessary number of geriatricians and
help them access the same level of
some other medical specialties, as well
service and enjoy the same outcomes
as registered and enrolled nurses, in
as others.
aged care.
As people live longer with long-term
New investment approaches
conditions and complex needs, either
If we continue to fund health services in at home or in aged residential care,
the way we currently do, care of older we will increasingly need to support
people will account for 50 percent of and develop the skills of our nursing,
DHB expenditure by 2025/26, up from allied and kaiāwhina (unregulated care
42 percent in 2015/16. It is vital that we and support workforce) workforces.
ensure we are getting the best value Some initiatives to sustain and grow
from the investments and resources the workforce are under way, including
across the health and social sectors. incentives to encourage graduate
nurses to the sector and programmes
The Ministry and other government
to support teams working together
departments are taking new ‘social
across all settings. However, these are
investment’ approaches to funding
Healthy Ageing Strategy 13not yet achieving significant gains. We Many are led by older people, together
need to be smarter in the way we make with local councils and a variety of
use of different parts of the workforce, organisations, who work towards local
such as the well-qualified pharmacist solutions to optimise older people’s
and allied health workforces. opportunities for healthy ageing,
participation, security and quality of
We need to make a priority of attracting,
life. Age-friendly communities provide
retaining and making the best use of
new opportunities for developing
the skills in the health workforce to
knowledge and skills for healthy ageing,
meet the needs of an older population.
and for the health sector to partner with
We need to ensure workforce training
older people in developing health and
keeps pace with technological change,
resilience.
and retraining is easily accessible for
staff, and is efficient and effective.
Integration across the
We also need to ensure that our health health and social sectors
workforce appropriately reflects our
growing ethnic diversity and ensure that Our approaches to the health and
it appropriately reflects and caters to a care of older people need to change
diverse older population. at multiple levels. We need better
communication between health service
users and providers, to ensure that
Families and communities services are as effective and efficient
We also need to ensure that family and as they can be. We need to improve
whānau carers receive support and the abilities of families, whānau,
information to be able to appropriately carers and communities to support
and safely care for older people. These and help care for older people. The
carers should also be supported health system needs to work with
to maintain their own health, and other sectors to take joint action on the
undertaking a caring role should social, environmental and economic
not exacerbate any existing health determinants of people’s health. Good
conditions or disabilities. housing and transport, for example, are
critical to keeping people well in their
We are starting to see the development own communities.
of age-friendly communities in
New Zealand. This term refers to More collaborative approaches will
communities that commit to physically enable us to be efficient and innovative
accessible and inclusive social living in the way we utilise specialist
environments that promote healthy and roles, such as nurse practitioners,
active ageing and a good quality of life, clinical nurse specialists and all
particularly for those in their later years. health professionals including allied
14 Healthy Ageing Strategyhealth professionals, such as dental view of performance. Three of the
hygienists, dieticians, occupational measures in particular (acute hospital
therapists and radiographers; bed days per capita, patient experience
pharmacists and paramedics, to of care and amenable mortality rates)
improve outcomes and enable highlight significant opportunities to
innovative models to develop in home improve the health outcomes of older
care, primary health care and residential people.
care.
We’re also able to make use of
new technologies and information
Smart system improvements. These technologies
Today’s health system is data-rich, with and improvements include initiatives
a tremendous volume of information that enable information to flow quickly
that can be harvested to create a much and freely to older people and to health
smarter system. workers, providers and families and
whānau; apps that provide immediate
The value and high performance theme information on an older person’s
of the New Zealand Health Strategy health status; and social media, which
emphasises the performance of the improves health professionals’ options
whole system and recommends for connecting with older people,
the development of an outcomes- families, whānau and carers in diverse
based approach to performance or isolated communities and helping
measurement. The Ministry has them to connect more easily with the
worked closely with the health sector services and information they need.
to develop a suite of system-level Improved information flows will also
measures that provide a system-wide help agencies to collaborate more
widely.
Healthy Ageing Strategy 15Vision and priorities
for action
The vision for this Strategy is that: Older people live well, age well and
have a respectful end of life in age-friendly communities.
16 Healthy
Healthy Ageing
Ageing Strategy
StrategyTo achieve this vision, we need to • better support older people with
ensure our policies, funding, planning high and complex needs
and service delivery: • provide respectful end-of-life care
• prioritise healthy ageing and that caters to personal, cultural and
resilience throughout people’s older spiritual needs.
years These five outcome areas form the
• enable high-quality acute and framework for this Strategy. We will
restorative care, for effective set out to achieve our vision in these
rehabilitation, recovery and five areas within a system that, as the
restoration after acute events New Zealand Health Strategy requires,
• ensure older people can live well is people powered, delivers services
with long-term conditions closer to home, is designed for value
and high performance and works as
one team in a smart system.
Figure 5: Strategic framework for healthy ageing
People-
powered
Ageing
well
Smart Closer to
system home
Support
for people Living
with high well with
Respectful
and health
end of life
complex conditions
needs
Acute and
restorative care
Value and
One team high
performance
Healthy Ageing Strategy 17Ageing well Te pai o ngātau o te kaumātuatanga This outcome area is about: • maximising people’s physical and mental health and wellbeing throughout their lives • developing health-smart and resilient older people, families and communities to help older people age positively • achieving equity for Māori and other population groups with poorer health outcomes • taking actions to improve the physical, social and environmental factors of healthy ageing • supporting the development and sustainability of age-friendly communities that enable older people to age positively. 18 Healthy Ageing Strategy
Why this is important Investing in healthy ageing has the
potential to increase the proportion of
Health is fundamental to being able
healthy, active and independent older
to live well, age well and continue to
people, prevent long-term conditions
participate in family and community
and their impacts on people’s lives and
life. Older people make a significant
result in long-term savings to the heath
contribution to our society, economically,
system.
socially and intellectually as mentors,
leaders and skilled workers and A healthily ageing and robust
volunteers. A healthy ageing approach population would help enable
seeks to enable older people to continue individuals to continue participating
to be active, engaged and enjoying life. in their communities and contributing
economically, socially and intellectually
While people may experience some
to a greater extent. Fewer people would
loss of strength and mobility over time,
require acute health interventions
many of the conditions associated
and would be able to stably maintain
with ageing (such as frailty) are not
themselves if they developed chronic
inevitable. The WHO estimates that
health conditions.
more than half of the health conditions
older people experience are potentially To ensure people age well, we need to
avoidable through lifestyle changes. focus on:
There is increasingly clear evidence • building physical and mental
that healthy lifestyles and physical and resilience
mental resilience are determinants of
• achieving equity in health across all
health in older age. There are also many
population groups
opportunities to benefit longer term from
• developing a health smart population
investing in social and environmental
through health literacy and helping
factors that influence health.
people to plan for their future health
Ageing well is not just about preventing and health-related needs
ill health and disability. It is also about • a health system that supports healthy
maximising physical and mental health ageing closer to home
and wellbeing, independence and • supporting people to plan for future
social connectedness as people age. health and health-related needs
Healthy ageing relates to all older
• improving social, physical and
people, including people with life-long
environmental determinants of health
disabilities or long-term conditions,
• promoting and supporting the
those recovering from injuries or poor
development of age-friendly
health, those with high and complex
communities.
needs and those in their final stages of
life. Subsequent chapters build on this
chapter.
Healthy Ageing Strategy 19Resilience that promotes older people’s sense
of self-worth and value to others.
Resilient people are more likely to age
We need to continue to reduce the
well and avoid cognitive decline or
stigma of depression and anxiety
loss of function until very late in life.
among older populations, and promote
Resilient people can overcome stressful
the factors and supports for greater
obstacles and recover from events that
mental wellbeing. We need to foster
might tip a less resilient person into a
approaches that build people’s
state of poor health.
strengths and capabilities, increase
Resilience develops through physical optimism and hope and reduce the
activity, healthy behaviours, mental potential and impact of depression,
wellbeing and social connectedness. anxiety and cognitive decline.
Our focus is therefore on increasing
physical activity and other healthy Equity
behaviours among older people – for
Reducing health inequities is a core
example, encourage good nutrition, not
component of a healthy ageing
drinking alcohol or only drinking at low-
approach and a priority for government.
risk levels, not smoking tobacco, taking
Equity is defined by the WHO as ‘the
part in mentally stimulating activities
absence of avoidable or remediable
and relationships that build people’s
differences among groups of people,
strengths and resilience.
whether those groups are defined
People staying active and connected socially, economically, demographically
as they grow older is critical. There is or geographically.’ Health equity
strong evidence that social isolation or approaches aim to improve fairness
loneliness is linked to poor mental and and reduce the incidence of avoidable,
physical health outcomes. We need to undesirable differences in health status.
increase awareness of this fact across
People differ in their ability to attain
the health system, and join with social
or maintain good health, for many
sector agencies, as well as community
reasons. Some population groups
and voluntary organisations to reduce
have markedly poorer health outcomes:
this risk factor and increase social
Māori, Pacific peoples, people with
interaction and connectedness.
intellectual disabilities, and people
We must also improve mental in socioeconomically deprived
wellbeing among older people. Social areas. Other groups, such as ethnic
connectedness, nutrition, physical communities and rural communities,
health and activity all contribute to are also vulnerable to poorer health
mental health, as does an environment outcomes.
20 Healthy Ageing StrategyOur focus on health equity aims to Empowering and supporting older
increase the age which these groups people to be ‘health smart’ in their later
can expect to remain in good health years requires the health system to
and independence and includes: have a strong understanding of what
• ensuring equity of access to health it takes to age well and takes part
services, including through innovative in achieving healthy ageing. We will
and effective services provided support older people in a way that is
closer to home, and catering to meaningful for them, and that is fully
people’s cultural preferences inclusive, where people are at the
• enabling equal opportunities to raise centre of the process. We will make
the capacity, functional ability and health information available and shared
wellbeing, by directing resources at in a way that overcomes cultural and
those with greatest need communication barriers.
• removing physical, financial, Planning for the future
institutional and other barriers to
high-quality health services and People’s needs change as they age,
equitable health outcomes and there may become a time when
a person is no longer able to make
• working across government and
decisions or advocate for themselves.
in communities on the social
Advance care plans and enduring
determinants of health, including
powers of attorney allow an individual
housing, elder abuse and neglect,
to retain a degree of autonomy in
negative attitudes and discrimination,
relation to their health care and
social isolation and inclusive, age-
treatment, minimise the potential for
friendly communities
conflict or harm, and reduce stress on
• minimising the impact of disability
family members and others. There is
and illness on people’s lives.
some evidence that advance care plans
can improve the experience of end-of-
Being health smart life care and their use across clinical
Health literacy disciplines is an integral part of a dying
People are empowered in their person’s coordination of care.
everyday lives when they can make Advance care plans and the
decisions that positively affect their discussions around them create an
health and care. Health literacy is the opportunity for people to think and
capacity to make good decisions, act talk about their values, preferences
on health information and navigate and beliefs. These conversations are
the health system. It is an essential easier when they begin well before
component of resilience and a priority the end of life. However, as people’s
of this Strategy. preferences often change over time, it
Healthy Ageing Strategy 21is also important that they be reviewed A strong, well organised primary health
and updated at key points and when care system that is provided close
circumstances change. to where people live and work will
empower individuals, enabling them to
The New Zealand Health Strategy
make informed choices and supporting
commits to supporting people and
them as they navigate their way
their clinicians to develop advance
through the health system. They also
care plans by building on existing
reduce health inequities and improve
national and international resources
population resilience.
and networks. We can also promote
advance care planning through, for
example, community organisations, Improving the social and
to help reduce stigma around talking environmental factors
about death and dying, and to increase influencing health
the likelihood that people receive quality
Together with other government sectors
health care according to their wishes.
and communities, the health system will
The quality of care is further discussed
work to improve the social, economic
in the ‘Respectful end of life’ section.
and physical factors for healthy ageing
We know that financial security is also and achieve equity, removing barriers to
important for mental wellbeing and participation.
healthy ageing. The Commission for
Financial Capability is carrying out a We need a coordinated, system-wide
national strategy and leading work approach to preventing, identifying and
across government and together with reducing elder abuse and neglect that
communities to grow New Zealanders’ includes providing accessible, well-
financial capability. Better financial tailored, effective services. As part of
capability will improve family and the Ministerial Group on Family Violence
community wellbeing, reduce hardship, and Sexual Violence work programme,
increase investment and grow the the health, social and justice sectors
economy, contributing to everyone’s are working together to develop an
resilience. integrated system for preventing and
responding to family violence and
sexual violence, including elder abuse
High-quality care closer to
and neglect, and reducing the impacts
home of such violence on wellbeing. The work
Primary health care services are is built around people-centred service
generally people’s first interaction with design and delivery, in the four areas
the health system when they are unwell. of primary prevention, identification,
They are where people receive most of incident response and follow-up
their professional medical advice. responses.
22 Healthy Ageing StrategyWe will work with housing providers Age-friendly communities
to improve the quality and range of and workforce
age-friendly housing for older people.
Age-friendly communities are
This will include a focus on rental
accessible and inclusive. They value
housing stock, which older people
people of all ages, and optimise
are increasingly likely to live in, and
opportunities for healthy ageing,
supported living housing options. We
including in the areas of participation,
will work with social housing providers
dignity, security, and quality of life.
to ensure that social housing is warm,
Age-friendly communities ensure
safe and dry, and with others to
older people have a voice, including
promote options for housing that meet
those with disabilities and dementia,
the needs of an ageing population.
and marginalised older people. They
We will also look for opportunities with
recognise older people’s wide range
the housing development sectors to
of skills and resources, and ensure
understand the future housing needs of
that communities protect those who
an ageing population.
are most vulnerable. They anticipate
Transport solutions are needed to and respond flexibly to the changing
reduce social isolation and improve physical, mental and social needs and
older people’s ability to participate in preferences of older people and ageing
their communities and access health populations.
and other social services. Government
The ‘age-friendly’ concept and its
agencies will work with transport
implementation have significant
providers to increase access to
momentum internationally and is
alternative means of transport for older
starting to gain pace in New Zealand.
people, to help prevent isolation. They
The Office for Seniors will lead the
will work to increase the flexibility of
development, through a co-design
social services in areas where transport
process, of a New Zealand-centric
options are most limited.
approach, and further develop the
Whānau ora service approaches are resources and networks to guide
examples of how agencies can work communities through the process of
well together to reduce the social, becoming age-friendly.
physical and environmental barriers
Across central and local government
some people face to achieving good
agencies, and in partnership with
health and wellbeing.
communities, we will support older
people and promote age-friendly
communities throughout New Zealand.
We will support older people and others
leading age-friendly communities
Healthy Ageing Strategy 23locally. Together we will work to Goals for healthy ageing
improve policies, services, structures
• Older people are physically, mentally
and environments, particularly outdoor
and socially active, have healthy
spaces and buildings, transport,
lifestyles and greater resilience
housing, social participation, respect
throughout their lives, meaning that
and social inclusion, civic participation
they spend more of their lives in
and employment, communication,
good health and living independently.
and health and social services. Our
collaboration will enable collective • Older people are health smart, able
impact at the national, regional and to make informed decisions about
local levels. their health and know when and how
to get help early.
An integrated health workforce with • Everyone in the health system and in
knowledge of social determinants of the wider social sector understands
health, culturally competent and with what contributes to healthy ageing,
a focus on wellness and upstream and takes part in achieving it.
early intervention in supporting healthy
• All older populations in New Zealand
lifestyles is an important contributor to
are supported to age well in ways
age-friendly communities.
appropriate to their needs and
cultures.
• Communities are age-friendly with
initiatives to keep people healthy,
well-connected, independent,
respected and able to participate
fully in their communities and with
family and whānau.
24 Healthy Ageing StrategyAcute and restorative care
Ngā tuāhuatanga manaaki, whakaora i te
hunga māuiui
This outcome area is about:
• ensuring appropriate admissions to hospital for older people with
acute or urgent clinical/care needs
• coordinating care across specialities and between ACC and the
health sector
• ensuring hospital stays are safe for older people who are frail,
vulnerable or have dementia
• helping older people to regain, maintain or adapt to changed levels of
function after an acute event
• looking for ways to weave family or whānau and wider community
support into an older person’s recovery and ongoing functioning.
Healthy Ageing Strategy 25Why this is important However, at the other end, premature
discharge may result in loss of
Older people benefit from access to
functioning or condition in the older
a wide range of hospital services,
person or even readmission. Premature
including emergency or acute services.
discharge can also cause significant
But unnecessary emergency visits, and
stress for family, whānau and carers
inappropriate admissions are stressful
who feel unprepared and unsupported.
for the individuals and use valuable
resources. When an older person returns home
after a stay in hospital, they may need to
Ambulance services and emergency
make adjustments to their daily routines,
departments are generally the first
and they may require temporary or
services to deal with acute and
ongoing support. Re-integration to
potentially life-threatening situations.
family, whānau and community life is a
But they may not be the best places for
key goal at this stage.
older people whose conditions could
be managed at home or by their local Successful treatment of an acute event
primary health care clinics or aged and effective follow-up care are reliant
residential care homes. on proactive and integrated planning,
timely treatment and a team approach.
Once in hospital, older people can
Planning needs to involve the individual
be especially vulnerable to rapid
and their family and whānau and should
deterioration putting them at risk of
address physical, mental and spiritual
further harm, (eg, by acquiring an
aspects.
infection).
Service providers and staff need
When older people stay in hospital
to understand cultural and other
too long, they face the risk of further
preferences, and be committed to
decline in their health associated with
working with Māori, Pacific and other
reduced physical activity (leading to
organisations, families, whānau and
loss of muscle tone and the chance of
community leaders to get the best
bed injuries), stress leading to increased
outcomes possible for individuals.
confusion, and inappropriate medication.
Older people told us that they want their:
These factors can lead to loss of
• urgent care needs managed at the
confidence and social contact and
right level (that is, don’t take them
are strong predictors of increased
to hospital if they don’t need to go
length of stay, long-term cognitive
there)
impairment, complications or death, as
well as higher costs for care. They can • assessment and other important
also mean a slower recovery for the information to be available to all who
individual and increased distress for need it (that is, not to have to repeat
family, whānau and carers. their information several times over)
26 Healthy Ageing Strategy• families, whānau and carers involved Family and carers could be the ‘eyes
in their rehabilitation and planning for and ears’ of an older person’s care
their return home team and initiate timely interventions.
• discharge, ongoing rehabilitation, Some DHBs have developed ‘pathways
home support and equipment of care’, that is, guidelines for assessing
organised in a timely way. and managing particular conditions (eg,
Therefore we will focus on improving strokes or heart disease) to improve
the three main parts of the journey the coordination and documentation
for older people – managing acute of care. Such pathways can reduce
presentations, providing safe, quality unplanned referrals to hospital.
treatments in hospital stay, and We need to spread innovations that
ensuring supported discharges and reduce the need for unnecessary
rehabilitation into the community. intensive services.
Ambulance services in the Kāpiti Coast
Managing acute
region, out of Wellington, are using an
presentations
‘urgent community care model’ and
To reduce unnecessary admissions, Healthline, as well as frontline triaging in
we need a system-wide response, emergency departments. Gerontology
including prevention, timely primary nurse specialists in the Waitemata
health care responses for older DHB provide assessments and care
people with acute needs, better coordination across primary health
communication between providers and care and hospital services for complex
systems, coordinated clinical and social wound care to be managed in the home
care, links between regular hours and or aged residential care setting, thus
after-hours services, and engagement reducing the risk of an older person’s
with community providers. health deteriorating and the need for
acute care.
The first stage of the journey is
prevention. A range of people can We will encourage and support such
have a role in this stage, including innovations, evaluate their outcomes
general practitioners, pharmacists, and spread good practice.
physiotherapists and home support
workers. All these primary care Safe, quality treatment in
givers should be able to recognise a hospital
deteriorating or acute situation and know
where to go for further advice before Hospitals can be frightening and
calling on emergency care services. bewildering places. Hospital staff need
to be acutely aware of the vulnerability
of older people, especially those who
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