Nurses and the decade of healthy ageing: An unprecedented opportunity

The United Nations (UN) declared this decade to be that of Healthy Ageing back in May 2020 (https://www.who.int/initiatives/decade-of-healthy-ageing). Is that declaration news to you? Don’t feel alone if you feel like this is the first you’ve heard about the Decade of Healthy Ageing (https://www.decadeofhealthyageing.org). Remember, throughout 2020, the world and especially we nurses were contending with the first months of this current COVID pandemic. The pandemic made it easy to miss anything that appeared unconnected to it, but missing the first year in the Decade of Healthy Ageing does not make this global initiative any less important. Indeed, the mission and aims of this initiative are vital to every person in every community around the world. Work we will do during the coming years as nurses and global citizens for this decade focused on healthy ageing and well-being during later life is then critical to ourselves, our families and our communities. Scan the title applied by the UN again: the Decade of Healthy Ageing. This initiative is focused on everyone living anywhere around the world. Ten years focused on a truly universal human aim, a foundation for a better tomorrow for every human being. That focus requires us to discard an assumption most nurses hold, however, implicitly. We must give up the notion of us—nurses, healthcare professionals, younger people—and them—older people. None of us can afford to think about older people and the process of getting to be one as some distant event. To exclude ourselves as we think about ageing healthily and well is to imagine that healthy ageing applies to a well-defined group of older people. Remember, whatever our chronological age now, we are all ageing, or at least hope to do so. Committing to healthy ageing is as essential to global health as it is to individual health. That commitment offers unparalleled power from which current models and modes of health care prevent us from realising. Dismantling ageism unlocks the power to realise our capacities for health and well-being. Our awareness of the extent to which ageism and other forms of social discrimination harm individual and global health is higher than ever before. The World Health Organization’s (WHO) Global Campaign to Combat Ageism (https://www.who.int/teams/social-determinants-of-health/demographic-change-and-healthy-ageing/combatting-ageism) emphasises how pervasive and harmful ageism is for people of all ages. The WHO Global Report on Ageism (https://www.who.int/teams/social-determinants-of-health/demographic-change-and-healthy-ageing/combatting-ageism/global-report-on-ageism) is a go-to resource every nurse can include in their library. That ageism counters healthy ageing is clear. Ageism is the social discrimination we wage against our future selves as we levy it on others. A pervasive and accepted expression of social and personal diminution, ageism affects health and limits healthy ageing. Ageism typically appears in concert with healthism—discriminating against people based on their perceived health status—and ableism—that discrimination expressed based on perceived ability and disability. Ageism also appears with and compounds healthism and ableism; racism and ethnocentrism; sexism and gender discrimination; queer, trans, and homophobia; and religious discrimination including Islamophobia and Anti-Semitism. Evidence points towards the extent to which individuals damage their own health by believing negative myths about getting older. Other evidence shows that ageism expressed towards others harms those people’s health, too. Nonetheless, the ways and extent to which healthism, ableism, and all other forms of social discrimination affect and promote what ageism does to health and well-being are less clear. Needs for high-quality science examining what ageism does to health and well-being and the mechanisms of those affects remain. Our call, as nurses, to promote health and well-being for people of all ages cannot simply be set aside as we await further science. This Decade of Healthy Ageing is our call to action. We frequently let the strengths of our nursing perspective fade in the shadow of the biomedically influenced view of ageing as a process of loss and being old as a state of vulnerability and decline. The reality of proximate death is somehow taken in a biomedical review means to strip agency, assign a permanent state of vulnerability and presume superior knowledge. This approach belies who we are as nurses. We know a better way. Our implicit approach to personhood, strength and capacity towards older individuals and populations reveals who we truly are as nurses and portends our contribution to this Decade of Healthy Ageing. Values nurses around the world typically call up when asked about why they are nurses tell a different story than the allopathic model in which healthcare systems immerse us. We speak to holism, care, compassion, agape love and advocacy. We see people as individuals, families and communities as partners in care. Those people are our patients and clients only in relationship to us as nurses. Without patient or client, there is no nurse. Models of nursing emphasise person, nurse, self-care, conservation of the person, health, well-being and environment. Why then do we let ageism block those values and shift our focus? Too often situations and settings damp down our nursing perspective, allowing the structural ageism of health care to rise. That ageism means what matters to the person is missed as their problem list surmounts all else. Their preferences, aims and priorities are left unknown as we and our healthcare colleagues seek to manage the list of their problems that we compile for and not with them. Such a biomedically centric approach belies a true sense of health and well-being in the salutogenic—or health promoting—sense inherent to our nursing perspective. Shifting away from the structural and individual ageism of health care and returning to our disciplinary values, we are set to see the Decade in the context of the UN’s Sustainable Development Goals (SDGs). A brief study of all 17 goals reveals direct and indirect links to healthy ageing and the consequence of greater well-being. Goal three—ensure healthy lives and promote well-being for all at all ages (https://www.un.org/sustainabledevelopment/health/)—is obviously connected to the role we can plan in this Decade. A bit of contemplation shows that goal ten—reduce inequality within and among countries (https://www.un.org/sustainabledevelopment/inequality/)—is also connected as effects of poverty among older people and poverty on health are quickly connected. Goals like SDG four—quality education (https://www.un.org/sustainabledevelopment/education/)—might seem irrelevant to healthy ageing with emphasis placed on children and young people. A closer examination tells a vastly different story. Unmistakable evidence points to foundational education and life-long learning as a key to healthy, long and well-lived lives. Quality education is then directly related to healthy ageing. This SDG is also indirectly related to healthy ageing if we consider teaching and who will instruct our children and young people. Many communities face shortages of teachers. Many older people contend with ageist employment discrimination. We know that meaning and a sense of purpose are integral to well-being in later life. Why not then call our older people to think about becoming teachers? Analysed in this way, the connection between goal four and healthy ageing is obvious and potential ways to attain this SDG and then help fulfil the Decade of Healthy Ageing quickly emerge. The goals focused on work and industry, like those addressing the needs of children, appear wholly disconnected from healthy ageing. But here again, our ageism is clearly getting the better of us as we draw this conclusion. Longevity economics tells us just how much older people contribute to work, industry, innovation and economies. Older people are far from an economic burden. More older people than ever before are working in paid and unpaid employment than ever before. These older people often do jobs like childcare and personal care for people of all ages who need support. They are thus enabling family members and neighbours to work at other jobs. Conversely, when older people need support themselves, they are creating employment for others. Among other groups, we nurses then benefit directly from older people’s economic influence, their work, and effects of the economic impetus they generate in myriad industries and for innumerable innovations including those in healthcare. The SDGs centred on the health of the planet may seem similarly separate from healthy ageing. In September 2021, the International Journal of Older People Nursing was one of over 200 journals to simultaneously publish an unprecedented editorial on the climate crisis and the imperative to restore a healthy climate (Atwoli et al., 2021). We all hold fast to the assertion that global heating imperils all health and specifically health in later life, meriting emergency action among global and national leaders, industry, and global citizens. The SDGs addressing sustainability, recycling and restoring all aspects of our planet’s health are fundamental to healthy ageing. The choice is simple to say but difficult to comprehend. We can choose an unhealthy planet and try to nurse the unhealthy people who live and die on it or work towards a healthy planet and with it a healthy climate where people can age healthfully and well. Around the world, not one person—including all nurses—will age with health and well-being if we do not limit global heating to less than to no more than 1.5℃ to 2℃. Achieving that aim mandates we decarbonise all industries—including health care—and all communities while actively repairing and protecting all environments around the world. Globally, nurses are already making progress on decarbonising health care and, with all of us working together, even more change is possible. Our opportunity in the Decade of Healthy Ageing is immense. Goal 17—Revitalise the global partnership for sustainable development (https://www.un.org/sustainabledevelopment/globalpartnerships/)—speaks directly to how we can capitalise on that opportunity. While goal 17 emphasises building back new and stronger partnerships in the aftermath of the pandemic, the connection to the Decade of Healthy Ageing is evident and actionable. The pandemic threatened healthy ageing in a myriad of ways. It highlighted longstanding shortcomings in care for older people. Moreover, COVID infection itself is likely to threaten healthy ageing with long-term effects on many body systems including neurological and endocrine. Partnerships crossing traditional sector boundaries are essential to revitalise work towards SDGs and essential to the Decade of Healthy Ageing. Our perspective as nurses, freed from structural and individual ageism and concomitant discrimination, is needed throughout health care and beyond. Our nascent collaborations in social care and integrated social and health care for older people offer examples to help us cross-sector boundaries to create new and stronger partnerships. We must also look beyond social and health care, across our wider communities, to fully capitalise on opportunity in the remaining years of this decade and beyond. The International Federation for Ageing (IFA) is leading the charge to achieve civil society engagement in the Decade of Healthy Ageing. The Civil Society Mapping and Engagement Initiative (https://www.decadeofhealthyageing.org/topics-initiatives/other-initiatives/civil-society-mapping) aims to leverage partnerships between and among civil society organisations to improve the lives of older people, their families, and their communities by shaping policy and action around the world. The IFA is calling on organisations and institutions across all disciplines and sectors to get involved in The Civil Society Mapping and Engagement Initiative. That’s where you can get involved! The Civil Society Mapping and Engagement Initiative is a portal for us to capitalise on the opportunity this Decade of Health Ageing holds. Healthcare organisations are obvious partners, with the initiative offering great alignment with Age Friendly and Dementia Friendly initiatives. We can urge our employers to get involved in the mapping process and to consider strategic and operational linkages with planned and existing Age Friendly and Dementia Friendly endeavours. Moreover, as nurses, we are engaged in many other organisations across our communities and societies. We might staff a health or other type of committee at our place of worship, volunteer at a foodbank, contribute to a charity shop, or sit on the board of a corporation. Any of those organisations are perfect candidates to connect to the Civil Society Mapping and Engagement Initiative, reflect on the Decade of Healthy Ageing, and plan how to get involved. We nurses, with our many commitments and roles, are well positioned to be catalysts for such involvement. We urge our fellow nurses and citizens to embrace the Decade of Healthy Ageing. The opportunities and possibilities for good that benefit us and the places—communities, societies and the planet—that we call home are limitless. Realising the power of being healthy, defined as an ever-expanding salutogenic state that affects all aspects of our lives as we live them, is empowering. Together, we can capitalise on that power now, during this current Decade of Healthy Ageing, and beyond. As we move forward to achieve the aims of this Decade, please consider sharing your research with us here at Geriatric Nursing, International Journal of Older People Nursing, Journal of Gerontological Nursing, or Research in Gerontological Nursing, depending on the audience you wish to reach. Highlight your research, civil society partnerships, and activities related to the Decade of Healthy Ageing and the UN SDGs on social media. To do so, just follow all our journals on Twitter (@gnjournal @IntJnlOPN @JGNJournal @RGNJournal) and join the IJOPN Facebook page at https://www.facebook.com/IJOPN/. Tag @UNDecadeAgeing, @IntFedAgeing, and @UN_SDG when you share your research and civil society engagement related to the Decade of Healthy Ageing. Please also use the hashtags #HealthyAgeing (or #HealthyAging), #GlobalGoals, and #GeroNurses. As #GeroNurses, we know that #HealthyAgeing is chief among our #GlobalGoals! Acting together, we truly can achieve #HealthyAgeing for all.

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