Associate Professor Frances Batchelor ( PhD ) Research and clinical physiotherapist ; acting director , National Ageing Research Institute ; and research lead for the Melbourne Ageing Research Collaboration , Melbourne , Victoria .

Professor Bianca Brijnath Director of social gerontology at the National Ageing Research Institute , Melbourne , Victoria .

Kerry Hwang Research assistant with the Melbourne Ageing Research Collaboration , National Ageing Research Institute ; and current PhD candidate at the University of Melbourne , Victoria .

Professor Pazit Levinger ( PhD ) Principal researcher , National Ageing Research Institute ; Rehabilitation , Ageing and Independent Living Research Centre , Monash University ; Institute for Health and Sport , Victoria University , Melbourne , Victoria .

First published online on 27 January 2023

BACKGROUND

IN the coming years , Australia will

experience significant ageing of the population . People aged 65 and older form 16 % of the total Australian population , with this expected to grow to almost 25 % by 2066 . 1 This currently equates to 4.5 million people aged 65-74 , 3.5 million aged 75-84 , and 2.2 million aged 85 and older . 1

This change is coming sooner for some demographics ; by 2031 it is expected that about 20 % of Aboriginal and Torres Strait Islander peoples will be 50 or older . Aboriginal and Torres Strait Islander peoples aged over 50 are considered ‘ older ’ because of health inequities experienced in the context of colonisation , intergenerational trauma , socioeconomic disadvantage and lack of culturally appropriate care . 1

Within the context of our ageing population , the UN Decade of Healthy Ageing , and following the release of the Royal Commission into Aged Care Quality and Safety ’ s final report , there is an urgent need for global and local action on healthy ageing to increase ‘ healthy life expectancy ’. 2 , 3 , 4 There is a requirement for care that

implements a rights-based approach to ensure all are able to age well and lead socially engaged and meaningful lives , regardless of where they live . Central to this is the ongoing dismantling of the negative assumptions about older people , caused by ageism in society — and by extent , in healthcare .

This How to Treat aims to provide GPs with an understanding of the holistic concept of healthy ageing and provides information on four key issues that impact their patients ’ ability to age well — dementia , falls , mental health and elder abuse .

WHAT DO WE MEAN BY ‘ HEALTHY AGEING ’?

AGEING is a complex biological process

, is associated with increased risk of disease , and leads to gradual decline in function and eventually death . However , the concept of ‘ ageing well ’, also known as healthy ageing , is not just the absence of disease . The WHO defines healthy ageing as “ the process of developing and maintaining the functional ability that enables wellbeing in older age ”. 5

In essence , for older people , healthy ageing is “ the ability and capacity to do what you value ”. 5 Increased life expectancy means most older adults will have one or more chronic conditions , and the socioeconomic determinants and health experiences through childhood and middle age will affect the individual ’ s health status . Healthy ageing incorporates both prevention and management of acute and chronic conditions , with the aim of ensuring optimal physical and mental health to enable a meaningful quality of life . This requires both population-level and individual action .

The ability to maintain functional capacity ( also known as functional ability ) and physical independence have been identified as key drivers for ageing well ; these are dependent on an individual ’ s intrinsic capacity , their environment and interactions between the two ( see figure 1 ). The WHO ’ s Integrated Care for Older People ( ICOPE ) framework highlights the need for healthcare systems to focus greater attention on addressing common losses in an individual ’ s intrinsic capacity that are associated with ageing . 6

HOW TO SUPPORT HEALTHY AGEING FOR ALL

Check your biases

WHEN working with older people , health professionals must first check

their own biases and assumptions about ageing ( see table 1 ). There is a tendency to view poor health as a ‘ normal ’ part of ageing , reflecting a prevailing attitude of ageism . Ageism perpetuates ideas that older people are frail , cognitively slow , helpless , weak and a burden on society and the economy . 7 Ageist attitudes have been noted among health providers and impede the care older people receive . 8 In healthcare settings , ageism frequently manifests in interactions between health professionals and older patients . Carers may unintentionally patronise older patients , ignore their views , give less time to clinical interviews and attribute symptoms to age as opposed to treatable conditions . 9 , 10

Overall management approach

Our health services and systems

have traditionally focused on diagnosis and management of medical