Implementation of the World Health Organization Age-Friendly Principles: A Case Study from Portugal
Abstract
:1. Introduction
2. Materials and Methods
2.1. Research Questions
2.2. Participants
2.3. Data Collection
2.4. Variables
2.5. Data Analysis
2.6. Ethical Considerations
3. Results
3.1. Sociodemographic Characterization
3.2. Knowledge of Age-Friendly Principles
3.3. Importance of the Age-Friendly Principles
3.3.1. Adequacy of the Structure of Health Services for Older Adults
3.3.2. Impact of Implementing the WHO Principles
3.4. Implementation of the Age-Friendly Principles
3.4.1. General Concept
3.4.2. Principle of “Information, Education, Communication, and Training”
3.4.3. Principle of “Healthcare Management System”
3.4.4. Principle of “Physical Environment”
4. Discussion
Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A
Variable | Response Scale |
---|---|
Sociodemographic data | |
Sex | Male Female |
Age group (in years) | <40 41 to 50 51 to 60 >60 |
Health organization where you carry out your professional activity | Primary healthcare Hospital healthcare |
Management position currently held | Coordinator Technical Council President Clinical Director Nurse Director Executive Member Other |
Total experience in the management bodies suggested above (in years) | <3 4 to 6 7 to 9 10 to 12 >13 |
Knowledge of the concept | |
Are you aware of the Age-Friendly Principles developed within the scope of healthcare? | No Yes |
What is the main source of this knowledge? | WHO European Commission Institutional Other |
Are these concepts familiar to you?
| No Yes |
Do you know the WHO guidelines regarding the reorientation of healthcare for older adults? | No Yes |
Are you aware of the measures proposed by the Directorate-General for Health, in the National Strategy for Active and Healthy Ageing 2017–2025? | No Yes |
Pertinence of the concept | |
Do you consider that the current organizational structure of health services may represent a problem in provide care to older adults with comorbidities? | No Yes |
Do you consider the information, education, communication, and training of the professionals in the Unit you manage to be adequate for the profile of the older adults who needs healthcare? | No Yes |
Do you consider that, in general, the management system and care process of the Unit you direct is adjusted to the health needs of the older adults? | No Yes |
Do you consider that, in general, the internal physical space of the Unit you manage is accessible to the older adults? | No Yes |
Do you consider that, in general, the physical space surrounding the Unit you manage allows unrestricted mobility for older adults? | No Yes |
Indicate the impact that the following actions would have on the promotion of Healthcare for Older Adults:
| Very little Little More or less Very Quite |
Implementation of the concept | |
General concept: | |
1. Does the health organization develop an age-friendly policy that values and promotes the health, dignity, and participation of older adults? | No Yes Do not know |
2. Does the health organization’s strategic plan identify compatibility with the older adults as a priority issue? | No Yes Do not know |
3. Does the health organization have a team for the coordination and implementation of the Age-Friendly Principles? | No Yes Do not know |
Information, Education, Communication, and Training: | |
1. Are there instructions and tools needed to provide preventive services—in particular, behavioral counseling on the three main risk factors: smoking, sedentary lifestyle, and unhealthy diet? | No Yes Do not know |
2. Are there specific protocols for the evaluation and clinical management of older adults users? | No Yes Do not know |
3. Are there protocols for dealing with issues of older adults abuse in suspected or confirmed cases? | No Yes Do not know |
4. Are health professionals trained, provided by the organization itself, on verbal and non-verbal communications suitable for older adults? | No Yes Do not know |
5. Do the other employees have training, given by the organization itself, on verbal and non-verbal communications suitable for older adults? | No Yes Do not know |
6. Are health professionals sensitized by the organization itself to the normal ageing process and its characteristics? | No Yes Do not know |
7. Are other employees made aware by the organization itself of the normal ageing process and its characteristics? | No Yes Do not know |
8. Are health professionals trained by the organization in the four geriatric syndromes (memory loss, urinary incontinence, depression, and falls)? | No Yes Do not know |
9. Are health professionals trained by the organization in the two most prevalent chronic diseases (diabetes and hypertension)? | No Yes Do not know |
10. Are health professionals trained by the organization to provide preventive services and advice on the three main risk factors: smoking, sedentary lifestyle and unhealthy diet? | No Yes Do not know |
11. Are health professionals aware of the existing health programs in the municipality, the health policies aimed at the older adults and their rights? | No Yes Do not know |
Healthcare Management System: | |
1. Are users aged over 65 advised, examined, treated and monitored annually? | No Yes Do not know |
2. Is there a priority system for older adults in all services? | No Yes Do not know |
3. Is there an exclusive queue for older adults at the service counters? | No Yes Do not know |
4. Are volunteers available to guide older adults through different services? | No Yes Do not know |
5. Are prescribed medications clearly explained to older adults? | No Yes Do not know |
6. Are all medical guidelines arising from the medical appointment provided to the older adults, family member, or caregiver in writing? | No Yes Do not know |
7. Is home healthcare available, with health professionals traveling to the homes of older adults, if necessary? | No Yes Do not know |
8. Is there sharing of clinical information on older adults between different levels of care? | No Yes Do not know |
9. Does the health organization designate a care coordinator for older adults? | No Yes Do not know |
10. Are there specific screening protocols for older adults (e.g., geriatric screening)? | No Yes Do not know |
11. Is there a multidisciplinary clinical area specialized in the older adults (e.g., geriatrics)? | No Yes Do not know |
12. Is a list of (in)formal caregivers or social responses available for older adults? | No Yes Do not know |
13. Can caregivers or family members monitoring older adults throughout the caregiving process? | No Yes Do not know |
14. Is there a specific medical appointment reminder system for older adults? | No Yes Do not know |
15. Is there a system that allows the reduction of healthcare costs for older adults? | No Yes Do not know |
16. Is there an exclusive nursing room for older adults? | No Yes Do not know |
17. Is there any area and/or form of recreation for older adults? | No Yes Do not know |
18. Is there a prayer room for each department (aggregation of services)? | No Yes Do not know |
19. Is the waiting time between arriving at the location and carrying out the medical appointment minimized for older adults? | No Yes Do not know |
20. Is there a specific opening hours for older adults? | No Yes Do not know |
21. Do older adults have extra time for medical appointments? | No Yes Do not know |
22. Is there a priority system for older adults when scheduling appointments? | No Yes Do not know |
23. Is the amount to be paid for the care prepared and disclosed to the older adults the day before the medical appointment? | No Yes Do not know |
24. Is an ethics specialist available to advise professionals and users on issues related to healthcare for older adults? | No Yes Do not know |
25. Is there an accessible way for older adults to assess their satisfaction in addition to the complaints book? | No Yes Do not know |
Physical Environment: | |
1. Are signage posted in all important areas (waiting rooms, doctors’ offices, hallways, bathrooms)? | No Yes Do not know |
2. Is the font size on signage large and bold for better visibility? | No Yes Do not know |
3. Are all words and signs written in Portuguese? | No Yes Do not know |
4. Are professionals easily identifiable through nameplates or clothing? | No Yes Do not know |
5. Are there parking spaces reserved exclusively for older adults? | No Yes Do not know |
6. Is there a bus and/or train station close to the health organization? | No Yes Do not know |
7. Is there an entrance adapted for older adults (e.g., level floor, ramp, handrail)? | No Yes Do not know |
8. Is there good lighting inside and outside the spaces (e.g., natural light, artificial white light)? | No Yes Do not know |
9. Are all doors wide (entrance door: ≥0.90 m; interior doors: ≥0.80 m)? | No Yes Do not know |
10. Are there elevators available for older adults on all floors? | No Yes Do not know |
11. Are the elevators and corridors wide and spacious for older adults to move around easily (elevator: 1.10 m wide × 1.40 m deep; corridor: ≥1.20 m wide)? | No Yes Do not know |
12. Is the interior of the health organization not complex and is access to different areas easy (e.g., demarcation signs, identification signs)? | No Yes Do not know |
13. Is there a sufficient number of chairs in the waiting room for each service (minimum of 20)? | No Yes Do not know |
14. Are floors non-slip in all areas (e.g., offices, hallways, bathrooms)? | No Yes Do not know |
15. Are there grab bars on the stairs on all floors? | No Yes Do not know |
16. Are toilets available in all major areas and on all floors? | No Yes Do not know |
17. Is there an emergency alarm in each bathroom? | No Yes Do not know |
18. Are bathroom floors always clean and dry? | No Yes Do not know |
19. Are there grab bars in all bathrooms? | No Yes Do not know |
20. Is there supervision of older adults when they use the bathroom? | No Yes Do not know |
21. Do the bathrooms have doors that open in both directions? | No Yes Do not know |
22. Are assistive technologies available for older adults (e.g., walking support, food, hygiene, communication)? | No Yes Do not know |
23. Is there a telephone or mobile phone available for older adults to use? | No Yes Do not know |
24. Are there free water points for older adults? | No Yes Do not know |
25. Are snacks available for older adults? | No Yes Do not know |
Appendix B
Total | |
---|---|
n (%) | |
Sex | |
Male | 50 (28.9) |
Female | 123 (71.1) |
Age group | |
<40 years | 65 (37.6) |
40 to 50 years | 48 (27.7) |
51 to 60 years | 31 (17.9) |
>60 years | 29 (16.8) |
Health organization | |
Primary Healthcare | 129 (74.6) |
Hospital Healthcare | 44 (25.4) |
Management position | |
Primary Healthcare | |
Coordinator | 64 (37.0) |
Technical council | 56 (32.4) |
Hospital Healthcare | |
President | 5 (2.9) |
Clinical director | 11 (6.4) |
Director nurse | 15 (8.7) |
Executive member | 9 (5.2) |
Other | 13 (7.5) |
Total experience in management | |
<3 years | 83 (48.0) |
4 to 6 years | 39 (22.5) |
7 to 9 years | 15 (8.7) |
10 to 12 years | 16 (9.2) |
>13 years | 20 (11.6) |
Total | ||
---|---|---|
n (%) | ||
No | Yes | |
Age-Friendly Hospital | 129 (74.6) | 44 (25.4) |
Age-Friendly Primary Healthcare | 138 (79.8) | 35 (20.2) |
Age-Friendly Emergency Service | 166 (96.0) | 7 (4.0) |
Age-Friendly Surgery Service | 169 (97.7) | 4 (2.3) |
Age-Friendly Acute Care | 170 (98.3) | 3 (1.7) |
Age-Friendly Health System | 154 (89.0) | 19 (11.0) |
None of the above | 60 (34.7) | 113 (65.3) |
Total | ||
---|---|---|
n (%) | ||
No | Yes | |
Knowledge of strategies to improve the training of professionals, the care system, and the physical environment | 92 (53.2) | 81 (46.8) |
Know the measures proposed in the National Strategy for Active and Healthy Ageing 2017–2025 | 68 (39.2) | 105 (60.7) |
Total | |||
---|---|---|---|
n (%) | |||
No | Yes | Do Not Know | |
The health organization develops an age-friendly policy that values and promotes the health, dignity, and participation of the older adults | 42 (24.3) | 100 (57.8) | 31 (17.9) |
The health organization’s strategic plan identifies compatibility with the older adults as a priority issue | 75 (43.4) | 67 (38.7) | 31 (17.9) |
The health organization has a team for the coordination and implementation of the Age-Friendly Principles | 122 (70.5) | 188 (10.4) | 33 (19.1) |
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Total | ||
---|---|---|
n (%) | ||
Knowledge of Age-Friendly Principles developed for healthcare | No | 123 (71.1) |
Yes | 50 (28.9) | |
Main source of this knowledge | WHO | 30 (60.0) |
European Commission | 5 (10.0) | |
Institution itself | 3 (6.0) | |
Other guidelines | 12 (24.0) |
Total | ||
---|---|---|
n (%) | ||
No | Yes | |
The organizational structure of health services represents a problem in provide care to older adults | 138 (79.8) | 35 (20.2) |
Information, education, communication, and training of professionals suited to the profile of the older adults who needs healthcare | 62 (35.8) | 111 (64.2) |
Management system and care process adjusted to the needs of the older adults | 86 (49.7) | 87 (50.3) |
Internal physical space accessible to the older adults | 35 (20.2) | 138 (79.8) |
The surrounding space allows unrestricted mobility for older adults | 63 (36.4) | 110 (63.6) |
Total | ||
---|---|---|
Impact | n (%) | |
Adoption of information, education, communication, and training measures for professionals in areas such as clinical geriatrics, communication with the older adults, and healthy ageing | Very little | 2 (1.2) |
Little | 5 (2.9) | |
More or less | 18 (10.4) | |
Very | 71 (41.0) | |
Quite | 77 (44.5) | |
Changes in the care management system, such as priority in care for older adults, specific opening hours, and geriatric screening | Very little | 7 (4.0) |
Little | 15 (8.7) | |
More or less | 51 (29.5) | |
Very | 51 (29.5) | |
Quite | 49 (28.3) | |
Adaptation of the physical environment through the application of universal design principles and easy access to public transport | Very little | 6 (3.5) |
Little | 11 (6.4) | |
More or less | 35 (20.2) | |
Very | 50 (28.9) | |
Quite | 71 (41.0) |
Total | |||
---|---|---|---|
n (%) | |||
No | Yes | Do Not Know | |
Are there instructions and tools needed to provide preventive services—in particular, behavioral counseling on the three main risk factors: smoking, sedentary lifestyle, and unhealthy diet? | 28 (16.2) | 141 (81.5) | 4 (2.3) |
Are there specific protocols for the evaluation and clinical management of older adults users? | 97 (56.1) | 67 (38.7) | 9 (5.2) |
Are there protocols for dealing with issues of older people abuse in suspected or confirmed cases? | 74 (42.8) | 80 (46.2) | 19 (11.0) |
Are health professionals trained, provided by the organization itself, in verbal and non-verbal communications suitable for older adults? | 129 (74.6) | 35 (20.2) | 9 (5.2) |
Do the other employees have training, given by the organization itself, in verbal and non-verbal communications suitable for older adults? | 131 (75.7) | 21 (12.1) | 21 (12.1) |
Are health professionals sensitized by the organization itself to the normal ageing process and its characteristics? | 60 (34.7) | 104 (60.1) | 9 (5.2) |
Are the other employees sensitized by the organization itself to the normal ageing process and its characteristics? | 77 (44.5) | 74 (42.8) | 22 (12.7) |
Are health professionals trained by the organization itself in the four geriatric syndromes (memory loss, urinary incontinence, depression, and falls)? | 90 (52.0) | 70 (40.5) | 13 (7.5) |
Are health professionals trained by the organization in the two most prevalent chronic diseases (diabetes and hypertension)? | 18 (10.4) | 148 (85.5) | 7 (4.0) |
Are health professionals trained by the organization itself to provide preventive services and advice on the three main risk factors: smoking, sedentary lifestyle, and unhealthy diet? | 45 (26) | 121 (69.9) | 7 (4.0) |
Are health professionals aware of existing health programs in the municipality, health policies aimed at the older adults, and their rights? | 43 (24.9) | 61 (35.3) | 69 (39.9) |
Total | |||
---|---|---|---|
n (%) | |||
No | Yes | Do Not Know | |
Are users over 65 advised, examined, treated, and monitored annually? | 35 (20.2) | 123 (71.1) | 15 (8.7) |
Is there a priority system for older people in all services? | 125 (72.3) | 41 (23.7) | 7 (4.0) |
Is there an exclusive queue for older adults at the assistance desks? | 156 (90.2) | 16 (9.2) | 1 (0.6) |
Are volunteers available to guide older people through different services? | 9 (20.5) b | 35 (79.5) b | 0 (0.0) |
Are prescribed medications clearly explained to older adults? | 8 (4.6) | 157 (90.8) | 8 (4.6) |
Are all medical guidelines arising from the medical appointment provided to the older adults, family member, or caregiver in writing? | 36 (20.8) | 106 (61.3) | 31 (17.9) |
Is home healthcare available, with health professionals traveling to older adults people’s homes, if necessary? | 20 (11.6) | 152 (87.9) | 1 (0.6) |
Is there sharing of clinical information on older adults people between different levels of care (e.g., between primary care and hospitals)? | 22 (12.7) | 142 (82.1) | 9 (5.2) |
Does the health organization designate a care coordinator for older adults? | 134 (77.5) | 28 (16.2) | 11 (6.4) |
Are there specific screening protocols for older people (e.g., geriatric screening)? | 157 (90.8) | 12 (6.9) | 4 (2.3) |
Is there a multidisciplinary clinical area specialized in the older adults (e.g., geriatrics)? | 152 (87.9) | 9 (5.2) | 12 (6.9) |
Is a list of (in)formal caregivers or social responses available for older people? | 78 (45.1) | 66 (38.2) | 29 (16.8) |
Can caregivers or family members monitoring older people throughout the caregiving process? | 14 (8.1) | 157 (90.8) | 2 (1.2) |
Is there a specific medical appointment reminder system for older adults? | 149 (86.1) | 14 (8.1) | 10 (5.8) |
Is there a system that allows the reduction of healthcare costs for older adults (e.g., exemption of user fees)? | 115 (66.5) | 24 (13.9) | 34 (19.7) |
Is there an exclusive nursing room for older adults? | 168 (97.1) | 3 (1.7) | 2 (1.2) |
Is there any area and/or form of recreation for older adults? | 163 (94.2) | 6 (3.5) | 4 (2.3) |
Is there a prayer room for each department (aggregation of services)? | 28 (63.6) b | 16 (36.4) b | 0 (0.0) |
Is the waiting time between arriving at the location and carrying out the medical appointment minimized for older adults? | 113 (65.3) | 52 (30.1) | 8 (4.6) |
Is there a specific opening hours for older adults? | 167 (96.5) | 4 (2.3) | 2 (1.2) |
Do older adults have extra time for medical appointments? | 153 (88.4) | 12 (6.9) | 8 (4.7) |
Is there a priority system for seniors when scheduling appointments? | 150 (86.7) | 15 (8.7) | 8 (4.6) |
Is the amount to be paid for care prepared and disclosed to the older adults the day before the medical appointment? | 148 (85.5) | 11 (6.4) | 14 (8.1) |
Is an ethics specialist available to advise professionals and users on issues related to the care of older people? | 133 (76.9) | 28 (16.2) | 12 (6.9) |
Is there an accessible way for older people to assess their satisfaction in addition to the complaints book? | 85 (49.1) | 81 (46.8) | 7 (4.0) |
Total | |||
---|---|---|---|
n (%) | |||
No | Yes | Do Not Know | |
Are signage posted in all important areas (waiting rooms, doctors’ offices, hallways, bathrooms)? | 10 (5.8) | 159 (92.4) b | 3 (1.7) |
Is the font size on signage large and bold for better visibility? | 36 (20.9) b | 132 (76.7) b | 4 (2.3) |
Are all words and signs written in Portuguese? | 1 (0.6) | 167 (97.7) b | 3 (1.8) b |
Are professionals easily identifiable through nameplates or clothing? | 32 (18.7) b | 137 (80.1) b | 2 (1.2) |
Are there parking spaces designated exclusively for older adults? | 147 (8.0) b | 19 (11.1) b | 5 (2.9) |
Is there a bus and/or train station close to the health organization? | 36 (21.2) b | 131(77.1) b | 3 (1.8) |
Is there an entrance adapted for older adults (e.g., level floor, ramp, handrail)? | 14 (8.2) b | 155 (90.6) b | 2 (1.2) |
Is there good lighting inside and outside the spaces (e.g., natural light, artificial white light)? | 11 (6.4) | 160 (92.5) | 2 (1.2) |
Are all doors wide (entrance door: ≥0.90 m; interior doors: ≥0.80 m)? | 16 (9.2) | 148 (85.5) | 9 (5.2) |
Are there elevators available for older adults on all floors? | 16 (12.5) b | 108 (84.4) b | 4 (3.1) b |
Are elevators and hallways wide and spacious for older people to move around easily (elevator: 1.10 m wide × 1.40 m deep; hallway: ≥1.20 m wide)? | 17 (11) b | 134 (86.5) b | 5 (2.6) b |
Is the interior of the health organization not complex and is access to different areas easy (e.g., demarcation signs, identification signs)? | 33 (19.1) | 138 (79.8) | 2 (1.2) |
Is there a sufficient number of chairs in the waiting room for each service (minimum of 20)? | 25 (15.1) b | 138 (83.1) b | 2 (1.8) b |
Are floors non-slip in all areas (e.g., offices, hallways, bathrooms)? | 88 (51.5) b | 68 (39.8) b | 15 (8.8) b |
Are there grab bars on the stairs on all floors? | 41 (29.9) b | 92 (67.2) b | 4 (2.9) b |
Are bathrooms available in all important areas and on all floors? | 16 (9.5) b | 150 (89.3) b | 2 (1.2) |
Are bathroom floors always clean and dry? | 24 (14.0) b | 134 (77.9) b | 14 (8.1) |
Are there grab bars in all bathrooms? | 78 (45.9) b | 76 (44.7) b | 16 (9.4) b |
Is there supervision of older adults when they use the bathroom? | 106 (62.4) b | 50 (29.4) b | 14 (8.2) b |
Do the bathrooms have doors that open both ways? | 140 (82.4) b | 20 (11.8) b | 10 (5.9) b |
Are assistive technologies available for older people (e.g., walking aids, food, hygiene, communication)? | 106 (64.2) b | 45 (27.3) b | 14 (8.5) b |
Is there a telephone or mobile phone available for older adults to use? | 123 (73.2) b | 35 (20.8) b | 10 (6.0) b |
Are there free water points for older adults? | 108 (63.2) b | 55 (32.2) b | 8 (4.7) b |
Are snacks available for older adults? | 114 (69.1) b | 46 (27.9) b | 5 (3.0) b |
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Tavares, J.; Santinha, G.; Rocha, N.P. Implementation of the World Health Organization Age-Friendly Principles: A Case Study from Portugal. Int. J. Environ. Res. Public Health 2023, 20, 6532. https://doi.org/10.3390/ijerph20156532
Tavares J, Santinha G, Rocha NP. Implementation of the World Health Organization Age-Friendly Principles: A Case Study from Portugal. International Journal of Environmental Research and Public Health. 2023; 20(15):6532. https://doi.org/10.3390/ijerph20156532
Chicago/Turabian StyleTavares, Jéssica, Gonçalo Santinha, and Nelson Pacheco Rocha. 2023. "Implementation of the World Health Organization Age-Friendly Principles: A Case Study from Portugal" International Journal of Environmental Research and Public Health 20, no. 15: 6532. https://doi.org/10.3390/ijerph20156532