People are living longer and we have an aging population, and with this comes increasing costs in the face of limited resources. In recent years there has been a shift in perspective of what age is considered to be ‘old’.
Indeed, the view of older people being a burden to society rather than actively contributing to the economy has become positively outdated, with the proportion of people aged 65+ remaining in employment being higher than ever; currently 1 in 10, compared to only 1 in 20 people aged 65+ working fifteen years ago. As well as through paid employment, older people actively contribute to the economy through volunteering, providing care and support to spouses in times of ill health, and providing childcare to grandchildren, enabling parents to work.
Recognising the important role of older people and valuing their positive contribution to the economy is an essential step for creating age-friendly communities. Government driven top-down programmes promoting wellbeing for communities are vulnerable to political cycles as funding priorities come under increasing attention ahead of an election. Therefore, action that is sustainable has to have co-production at its core, involving people to increase social engagement and taking an asset based approach to monitoring outcomes i.e. valuing the skills and experience that a community has and using them to drive positive change.
Alongside this shift in perspective about what ageing is, there has been a move away from traditional research methods to evaluate health benefits, which have typically focused on a narrow definition of health and have offered limited opportunity for the public to get involved with the design of the research. Researchers are increasingly acknowledging the value of involving the public in research as more than participants who research is conducted on, but as active partners in identifying what the important research questions are, and how to go about studying them.
With a change in thinking about what should be valued, economists face the challenge of how to measure health benefits and other outcomes in a non-traditional framework. There is very much still a place for traditional cost-effective, evidence based, interventions that improve the health and wellbeing of older people; however, policy makers increasingly favour the accessible language of return on investment evaluations. We can look to learn lessons from other sectors, such as education and transport, who have been using this framework to evaluate programmes for a long time however one issue to overcome is that methodologies and reporting practices vary widely across sectors, so it is difficult to apply lessons consistently to health research.
Whichever direction research into sustainable, age-friendly, communities takes, attention needs to be paid to how to disseminate findings in a way that is meaningful to the public. Furthermore, improving the evidence base about how to successfully implement programmes into practice is needed to help minimise the knowledge gaps between older people, researchers and policy makers.
Lucy Bryning and Carys Jones
Centre for Health Economics and Medicines Evaluation