Designing and implementing healthy ageing policies

Abstract

Dr Gareth Morgan from NHS Wales looks at how healthy ageing policies need to be implemented to ensure a success healthy ageing programme What is 'evidence'? The traditional hierarchy of 'evidence', ranging from metaanalysis of randomised controlled trials (RCTs) to expert opinion has limitations. For example, some situations may not be amenable to RCTs1 and furthermore, evidence may be open to interpretation and the application influenced by the specific context. 'Evidence-informed policy', at least in part, reflects the concept of the complex journey from evidence to implementation.2 Good evidence is not always effectively implemented. For example, there is good evidence, underpinned by meta-analysis of RCTs, that aspirin prophylaxis has a favourable benefit versus risk balance in the secondary prophylaxis of vascular events.3 Yet, there is evidence of an under-use of the medicine for this indication. 4 Does this represent a policy failure? Perhaps there may be underpinning issues at a primary care level? It might be individual choice, linked to the broader consideration of medicines management within the healthy ageing agenda? Or perhaps the under-use might be anticipated, indeed even accepted as inevitable, during the journey of evidence to implementation? Indeed, whilst acknowledging that the increased use of aspirin alongside other measures, such as smoking cessation, might help deliver substantial benefits,5 there are policy challenges. In terms of a theoretical conceptual framework, based on a review of the literature, six policy factors have been identified6 as important in underpinning 'evidence based health policy': (i) support by the national Government; (ii) the need for policy implementation to be locally sensitive; (iii) the need to have a broad evidence base to draw upon; (iv) the circular relationship between research and policy; (v) the importance and value of having multi-disciplinary teams and; (vi) the benefit of stakeholder involvement. A casestudy from Wales, 7 on the National Service Framework for Older People has found that these factors had been satisfied. Two independent studies in Wales have suggested variation in the provision of healthy ageing initiatives.8-9 In theory at least, this variation might be beneficial by developing locally sensitive approaches to healthy ageing. Such variation might also have disadvantages as well, however, such as inconsistency of initiative delivery and also difficulties in measuring impact. Indeed, Wales does contribute to the research 'evidence' on healthy ageing, for example, the 'Age Well Feel Good'10 programme is a prospective cohort study of older people in Wales. It has been established to collect information on factors pertinent to healthy ageing and also to explore the use of information technology in such studies. …