Back in 2013, HelpAge began a discussion about how we were measuring health in older age. This soon turned into a much bigger conversation about healthy ageing and the inadequacy of existing data collection on older people’s health. We began to explore what we need to know, and how we can support network members and partners to more effectively monitor the impact of community level projects.
Developing a robust tool to measure older people’s health
What we wanted was a tool that would allow us to monitor health status, as perceived by the older people we work with. Crucially, we needed to include measures of their wellbeing and level of functional ability. Our work over this period gave birth to our Health Outcomes Tool – a community-based survey tool on healthy ageing. It was designed with the primary purpose of measuring the impact of HelpAge’s health and care programmes, to inform how best to support health and functional ability in older age and to provide an evidence base to support our influencing work.
Between 2014 and 2017 we worked with network members and partners to test the tool in communities in nine countries in three regions. We made tweaks here and there as we learned from the experience of using the tool over this period. Through this testing we amassed a significant dataset, collecting data with over 3,000 older women and men aged between 50 and 112.
The data has been used by HelpAge staff, network members and partners in their communities to inform our programming, and at national level, in our influencing work with Ministries of Health. We have gone back to many of the communities to conduct a second, and sometimes third, round of data collection with the same older people, allowing us to start building up a picture of change over time. But following the testing phase we also wanted to pause, to bring together the data collected, to analyse it look for patterns and trends emerging from our work.
This week, we published the global report of this analysis, highlighting the key findings and making some key recommendations for governments and other service providers.
What the data tell us
The key findings of the report resonate with and support current thinking on ageing and health. The data shows certain groups of older people are being left behind: the oldest old; those in rural areas; those with lowest levels of education; and those least able to meet their basic needs.
Across the nine countries, the data showed access to health services declines with age and is poorest among older women and men in rural areas. As we would expect, affordability of health services appeared to be influenced by an older person’s socio-economic status, with those least able to meet their basic needs, and those with the lowest educational levels, least able to afford health services.
The report highlights that those older people who face the most significant barriers to health services also struggle to access care and support, and to engage in self-care. The oldest old reported the greatest challenge in accessing informal care and support, but interestingly people in the youngest age group also rated their access to care and support poorly. This could be linked to a perception among family and community members that they do not yet need support, or that they should be able to manage and take care of themselves.
The data we have collected across the nine countries suggests a strong link between access to health services, care and support, and perceived health and wellbeing. The same groups of older people who report challenges in accessing these services and support, also scored their health, wellbeing and functional ability most poorly.
Recommendations for government and service providers
Based on the findings of our data analysis, the report makes the following recommendations for governments and other service providers:
• Develop health and care services and support that: respond to evidence; target those being left behind; take into account older people’s needs and preferences; recognise that people in older age have a diverse range of needs.
• Include older people in all efforts to achieve universal health coverage and respond to the specific income insecurity faced in older age to ensure: health services are affordable and older people do not face financial hardship in accessing them; essential health service packages include the services most needed to address the health challenges common in older age.
• Develop and strengthen health and care systems to provide integrated care that is person-centred, responding holistically to older people’s needs.
• Support older people’s ability to self-care, providing older people with the information and education they need to make changes to their own lives to support healthy ageing.
• Ensure data collected on older people’s health and care is fully disaggregated by age, sex, disability, socio-economic status and location to provide a strengthened evidence base and enable greater targeting of interventions.
The report was developed with generous funding from Pfizer Inc., through our supporting member HelpAge USA. Thanks to HelpAge network members and partners: Javeriana Universidad in Colombia; GRAVIS in India; Coalition of Services of the Elderly in the Philippines; Health Nest Uganda; and Island Hospice in Zimbabwe. Lovemore Mupaza, Monitoring and Evaluation Officer at Island Hospice, Zimbabwe, writes:
“Island offers palliative care services to people suffering from life-limiting and life-threatening conditions. We were interested in using the tool for measuring programme impact because it holistically measures health outcomes at baseline, mid-term and end-term. Furthermore, the tool assesses not only physical pain but also emotional and psychological pain, which are critical components of palliative care.
HOT was fairly easy to administer, however, the process had its challenges. For instance, some older people have difficulties with their memory, making it difficult to collect accurate data from them. Some did not have identity cards to establish their actual ages. Some of the findings were surprising. For example, regardless of their age, a third of older people are primary caregivers for ill family members, and 40% depend on subsistence agriculture as their main source of income. Other information collected alongside the data from the health outcomes tool revealed problems with medication prescribing and dispensing services, as only 17% of health centres assessed stocked drugs for common conditions including hypertension and diabetes, and fewer than 10% were able to undertake routine screening for NCDs.
Our findings from the three rounds of data collection were used to inform policy and programming. Donors have since funded a successor project in Marondera, strengthening community participation and involvement of older people in development. In 2016, the findings were also used to inform design of Zimbabwe’s first healthy ageing strategy.”