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Annex B: Priority Areas for Action to Improve Health in Scotland
Mental Health and Well-Being
Improving mental health and well-being in later life is one of the six priority areas for action under the Scottish Executive's National Programme for Improving Mental Health and Well-being. This Programme has been informed by research as well as consultation with older people, practitioners, academics and policy makers at both national and local level. It is currently linking the UK Inquiry report's findings to action by Community Health Partnerships at local level. Respondents to the consultation recognised that mental health and well-being is as important as the physical, and responses revealed some real concerns on the part of older Scots about their self perception and well-being. This is consistent with the findings of the UK Inquiry into Mental Health and Well-Being in Later Life, where people said:
"It is upsetting to feel like a second-class citizen because I am above retirement age."
"What makes things worse is not having a sense of belonging. There needs to be a role for older people in society."
"The main thing is love. Food, shelter and warmth are important, but it's lack of someone caring that leads to despair."
"I worry about not being able to help my grandchild financially."
The UK Inquiry's first report Promoting mental health and well-being in later life (Age Concern and Mental Health Foundation, 2006) identified the main factors influencing mental health and well-being in later life:
- Ageism: which lowers self-respect and thus threatens mental health
- Participation: which enhances self-esteem through meaningful activity and giving a sense of purpose
- Relationships: which promote well-being through interactions, whether with friends and family or with pets. Spiritual faith and belief can also provide crucial support
- Physical health: which is inextricably linked with mental health
- Poverty: which is a risk factor for poor mental health.
The same report noted there is "no single, simple solution. ….. Some matters can only be dealt with by central Government or in national media campaigns. However, the majority of the changes that older people identify as important to their mental health and well-being can most effectively be addressed by activities at the local, community level".
The report went on to say that there is much that can be done, with examples as follows:
- include older people in community activities
- promote social interaction between people of all ages
- help strengthen the relationships older people have with their friends, family and neighbours
- tackle fears of isolation and loneliness
- recognise the importance of spiritual belief and faith communities and help older people to access them
- support people after bereavement
- promote age equality, particularly within mental health promotion
- work with the media to improve portrayals of ageing and older people
- educate and train all employees who have direct contact with the public to value and respect older people
- remove or reduce barriers to participation in later life
- recognise and tackle abuse and violence that affects older people
- promote physical activity for people of all ages, including disabled people
- promote a healthy diet and moderate alcohol consumption
- improve access to fresh, affordable foods
- tackle pensioner poverty for older people
- give people the choice to keep working in later life to maintain or increase their income.
Physical Activity and Falls Prevention
Regular physical activity is essential for health, and inactivity is as damaging to health as smoking or an unhealthy diet. Regular activity can have a beneficial effect on up to 20 chronic diseases and conditions. Physically active people have a 20-30% reduced risk of premature death, and a 50% reduced risk of major chronic disease such as coronary heart disease, stroke, diabetes and cancers; and physical activity can have a positive impact in promoting good mental health too (Department of Health, 2004).
Physically active older people maintain not only their health but their independence, their social interactions, and their contribution to the wider community. But we know from the 2003 Scottish Health Survey too few of today's older people are meeting the minimum recommendations of physical activity to maintain good health.
Only 30% of 55-64 year olds and 20% of 65-74 year olds are meeting the recommendations of 30 minutes a day on most days of the week, (Scottish Executive, 2005e). Greater physical activity in middle and later life offers not only the most effective but probably also the most enjoyable means of promoting health and therefore needs to be encouraged through the media and made more accessible through the design of local built and outdoor environments, through development of effective public transportation systems and provision of opportunities to participate in appropriate forms of physical activity, leisure and sport across Scotland.
Walking is recognised as the activity most likely to achieve health benefits at a population level, and especially so for older people. Paths to Health provides a good example of a health promoting service, currently with more than 10,000 people participating in led walks every week, of whom approximately 85% are aged 60+. The service is predominantly run by older people. It meets the needs of older people and also harnesses volunteering in the community, builds social networks, and works because people enjoy it - and all with the inbuilt advantages of requiring little skill and training, and hardly any equipment.
Falls Prevention
Falls are a major issue for older people - one in 3 people over 65 have a serious fall every year. Falls and their after-effects have a harmful effect on health, well-being and independence, and ultimately on a person's ability to live independently in their own home.
There are things that can be done to reduce the incidence of falls - these may be as simple as removing trailing flexes or loose carpets, dealing with badly positioned furniture or uneven flooring or steps, or fixing handrails and grab handles in the home. Safe environments for people with precarious mobility are especially important in institutions such as hospitals, day centres and care homes. Falls clinics provide more detailed assessments for patients who have had several falls, by reviewing medication, looking for treatable medical causes of falls, and providing guidance on exercise and balance training.
The Scottish Executive has been taking forward work in a Falls Working Group and the outcome is expected to be a letter intended primarily for Community Health Partnerships asking for specific action to be taken by them and by Health Boards.
Case Study: Scottish Healthy Communities Collaborative
The Scottish Healthy Communities Collaborative is working in local communities within Perth and Kinross (Perth, Crieff and Blairgowrie) and Argyll and Bute (Cowal and Bute). The approach used combines Community Development with Collaborative Change management concepts resulting in Community Action, and has a focus on falls prevention.
Greater Glasgow Health Board has a Strategy for Osteoporosis and Falls Prevention 2006, and Fife launched its Falls, Osteoporosis and Fracture Prevention in Fife Strategy 2006-2011 on 1 November 2006.
Smoking
In March 2006 Scotland became the first part of the UK to implement a smoking ban in enclosed public places and workplaces. It is now illegal to smoke in most indoor places other than private homes. This includes restaurants, bars, cafes, hotels, theatres, bingo halls, church halls, sports and shopping centres, public transport, schools, hospitals and clubs. It also covers almost all workplaces, including lorries and vans.
In practical terms this means smoking is no longer permitted in many of the places visited by older people, including day centres, social clubs, bars and restaurants. In adult care homes and residential psychiatric hospitals and units, smoking is permitted only in designated smoking areas which may be established by proprietors as long as certain criteria are met.
The health of older people is, of course, at significant risk from smoking. Smoking is not only responsible for a large number of premature deaths from smoking-related diseases, but also increased risk of illness and a reduction in quality of life. Many believe the damage has been done and there is little they can do to reverse the adverse effects of disease or symptoms relating to smoking. In reality, stopping smoking can provide increased quality and quantity of life in older adults - by adding both years to life and life to years.
Diet
After smoking, poor diet is the most significant contributor to poor health in Scotland. Traditional Scottish diets are high in fat, sugar, salt, confectionery and non-diet soft drinks and low in fruit and vegetables, with only a fifth of the population achieving the 5 a day target. Already the Scottish Executive has worked to: improve food access and expand availability of healthy food in low income areas; drive up standards in catering through the new Healthyliving Award; bring more healthy choices to the High Street; and transform the provision of food in Scottish schools and nurseries. Nutritional standards have been raised across the public sector, and awareness of healthy eating has been promoted through the Healthy Living Campaign, which markets healthy eating and physical activity as aspirational, desirable and achievable lifestyles for the majority of people in Scotland.
Alcohol
Over-use and abuse of alcohol remains a major health concern for Scotland and future levels of alcohol consumption may prove to be a major determinant of health and illness for older Scots. Currently, some 10% of over 65s exceed recommended drinking levels. Of the next generation of older Scots, those currently aged 45 to 64, double that proportion (20%) currently exceed recommended safe limits. If such levels are sustained into later life, the numbers of people whose health may be damaged by alcohol will increase from 80,700 to 223,500 by 2031 ( NHS Health Scotland, 2006). So for the baby boomers, alcohol abuse is a major threat, and a major challenge in health education and health-related behaviour.
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