Functioning and Disability in Ageing Population in Europe: What Policy for which Interventions?

6. Planning Health and Social Interventions in an Ageing Europe with ICF

Actually, the aim of the research on ageing is to develop instruments that will aid researchers in answering the following scientific questions:
• Is population ageing the major driver of future European epidemiological trends and burden of illness?
• Is the compression of morbidity phenomenon evident in Europe’s ageing population?
• Is ageing connected to a decrease in quality of life?
• Is ageing connected to a decrease of well being?
• What are the major determinants of ageing related outcomes?
With respect to the last three questions, it is our belief that current studies often do not clearly address the mechanisms that aim to explain the linkages between health, quality of life and well-being. These studies rely on measures that do not discriminate between these three constructs, which dramatically undermines their validity. This fact underscores the necessity to measure health, quality of life and well-being independently and against the background of a clear conceptual framework of health. That framework is provided by the ICF and clearly distinguishes the descriptive from the evaluative aspects of the overall health experience and provides the terminology and classificatory logic for describing human functioning and disability. ICF is explicitly a classification and NOT an evaluative framework, but, because of its descriptive power, it makes possible well-defined evaluations, such as quality of life, grounded in subjective satisfaction with levels of functioning or health states.
This allows the separation of the actual levels of difficulties experienced as descriptors of a person’s state of health from the importance or value that is assigned by the individual to the levels of functioning in different domains.
The ICF makes it possible to define individual levels of health in terms of objective states of capacities to function in a given set of domains, whereas a person’s quality of life is entirely a matter of their subjective appraisal of those states irrespective of the actual level of health, and well-being is a function both of a person’s subjective satisfaction with various aspects of life as well as his/her current affective state measured as a time-weighted metric of amount of negative or positive emotions.
Different political, economic and social interventions are needed to identify and respond to needs at those different levels. The use of ICF framework for policy planning in ageing requires further research, however ICF sets out an internationally comparable language of all dimensions of human functioning at the body, person and societal levels. Difficulties of functioning at the body level, or impairments, can therefore be conceptually and operationally distinguished from difficulties of functioning at the person or societal levels (activity limitations and participation restrictions). Since ICF’s model of disability is interactive — combining the best of the so-called medical and social models into a fully integrated model — ICF also contains a classification of environmental factors, that is, the physical, social and attitudinal factors that, as barriers, contribute to the creation of impairments, activity limitations and participation restrictions, or as facilitators increase or extend levels of functioning at the body, person or societal levels. The classification of environmental factors makes it possible, for the first time, to identify, assess and measure the impact of a person’s environment on his or her levels of disability. Thus ICF proves to be a useful instrument measuring health and disability in populations and for planning interventions at the level of the person or of his/her environment.

7. Conclusions

Ageing is the most important factor associated with declines in functioning and is the driving force for projections of magnitude of disability as confirmed by the EU MHADIE data analysis. It is recommended that future surveys should take more detailed measures to capture ageing phenomena. Solid and comparable data on functioning and disability are needed in Europe and the impact of disability on ageing has to be known so that policy planning may be facilitated. The collation of national data on service provision and outcomes for people with disabilities is both important and challenging. In particular, there is a need for better quality data from administrative systems, data that can be compared across time, across state and territories and across various health and welfare programs. There is also the requirement to compare the statistics produced from administrative sources with those from surveys and censuses, so that we can estimate the need for services and access to services by particular population groups. Ageing is a process and the measurement of determinants of ageing can be carried out at various stages of life. To understand the impact of disability in a population, the health impacts must be understood independently of the non-health or health-related impacts. The ICF framework and its bio-psychosocial approach, clearly identifying this scission, might be used for planning and policy intervention at different levels, as has been demonstrated by MHADIE research. Valid measurement of disability can only be achieved by surveys that elicit data about functioning levels in multiple life areas, rather than by means of a small set of impairment questions that produce invalid disability prevalence estimates, that distort policy planning and measurement of the change in interventions. This is an urgent and clear need in ageing populations’ surveys. Good data driving policy. The results of MHADIE research, suggest recommending that surveys use a multi-functional approach and that policy interventions are planned at body, persons and society level. With an ageing population, living longer and encountering more disabilities, only this approach will allow a rational definition of policy priorities in Europe.


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