Ageing. There are songs about it, books about it and jokes. Tropes on the topic abound: “You’re not getting older, you’re getting better.” “Sixty is the new 40.” And so on.
When it comes to the topic of ageing, few know more about it than Dr. Jane Barratt, Secretary General for the International Federation of Ageing (IFA), whose entire career has been focused on the ageing and disability fields. She’s a Winston Churchill Fellow and recipient of the Queen Elizabeth II Diamond Jubilee Medal in Canada for her commitment and passion for issues relating to ageing, and in September 2022, Jane was also recognized as one of 50 leaders working to transform the world to be a better place to grow old.
Jane grew up in Western Australia as one of five children and had a brother born with a heart defect called Eisenmenger syndrome. They were a very active family, but her brother, Paul, couldn’t do all the things that a child with good cardio capacity could do. This shaped the family, but it also shaped Jane as a person. Her deep love for her brother and her family was the beginning of her interest in serving those around her.
Jane became an occupational therapist by trade, the chair of the disability commission, and then an academic. Her master’s degree studies looked at the relationship between mothers with rheumatoid arthritis and their children, and her Ph.D. was trying to deeply understand how we identify and fund services for folks across the generations living with a disability.
“That’s what my frame of reference is,” says Jane, “what can we do in the environment to support someone? An understanding of how we travel through life, and how the environment can support and enable, or can be a barrier. And that’s not only physical, but also psychological, social and political.”
In 2000, Jane applied for and landed the position of Secretary General at the IFA, an international non-governmental organization with members in nearly 80 countries. The IFA’s goal is to help shape and influence policy and good practices to drive the agenda around ageing and to encourage investment in the health of the older population. It has a formal general consultative status relationship with the United Nations (UN).
“We have a program of work that is built around some of the agendas of WHO [World Health Organization], but we work in partnership with many country organizations. We inform WHO, OECD [Organization for Economic Cooperation and Development] and the UN, but we help build the capacity and capability of organizations on the ground,” says Jane.
At the IFA, the focus is on ageing starting at birth and a life course approach to ageing. “Of course, we’re on the journey of ageing from the moment we’re born, but it’s the last third of our life that is really the focus at the IFA,” says Jane.
The IFA and its partner organizations are now in the second year of the UN Decade of Healthy Ageing, a global collaboration which brings together 100 countries whose societies and government agencies have signed onto the agenda to improve the lives of older people, their families and community. The focus is on four main areas: age-friendly environments, combating ageism, integrated care and long-term care.
Jane explains that there are usually three main trajectories for ageing. There are those highly stable older adults with the capacity to be independent who may age into their eighties and nineties and be relatively independent. Then there are those who have a slow deterioration and declining function. They may have cardiovascular disease or diabetes but generally can function with some assistance. Finally, you’ve got that cohort that experiences a dramatic decline, whether it’s through illness, or someone who has dementia and has a slow decline that lasts a lifetime. “I think not about chronological age, but about function. How do we create an environment that enables people as they age?”
Although there has been progress in some areas on the topic of ageing, Jane advises that growth in other areas has been slow. “You only have to look at the last three years of a pandemic. In Canada and in many high-income countries, we were ill prepared for a pandemic, even though we knew the pandemic was going to come. When it came to those that were most at risk of infectious diseases – not just the frail, older people but also those 50 and older that have weaker immunity – we failed them, time and time again,” says Jane.
She gives the example that in the depths of winter, somebody decided we needed to line up for the Covid-19 vaccine in weather conditions that made it very difficult for older folks.
Although we’re currently living longer than in the past, ageing also often means increasing health comorbidities. Advancement has been made in understanding chronic conditions, but further work on prevention is still necessary. For example, we understand how to treat those with diabetes, with diabetic retinopathy and with cardiovascular disease. “We’re good at treating, but we are terrible at preventing, and our health promotion and prevention strategies are grossly underfunded,” says Jane.
This reorientation to health promotion and prevention falls off the table all the time, sometimes due to a political cycle. “We do not invest in health and wellbeing; we invest in the health system capacity to treat and manage disease. So, we start sitting in these disease conundrums,” she says.
Ageism is an area that is currently getting a lot of attention. Jane advises there are three kinds of ageism: self-identifying, interpersonal and institutional.
“If you think about the institutional, you can also put that lens over many of our policies. So how do our policies reflect that?” Jane continues, “We recognize that older people may require fairly targeted messages in terms of public health, for example around the value of them receiving a vaccine being equal to that of school aged children.” (Note, in Jane’s world, the word “senior” isn’t used, but rather “older” person or adult.)
“We also know that for those that do not feel positive about ageing and who experience discrimination live 7.5 years less,” says Jane. It’s this kind of evidence that makes this field so exciting for her. “Because it’s really very intricate and then, of course, you get the whole business philosophy – how does the industry understand the field of ageing and what innovations and technologies are available to create this enabling environment?”
Dr. Barratt also points out that today’s systems are designed for past generations and not current or future ones. For example, studies show the fear of vision loss is greater than the fear of cancer, and yet in many countries the pathway to see an ophthalmologist or retinal specialist is very complicated. If a person goes to their GP and then is diagnosed with diabetes, they might be referred to a diabetologist, but they also should be referred to an ophthalmologist because eye disease is a serious complication. And the doctor could also be saying, “I see that you’ve missed your Covid-19 vaccine, you know that’s going to be important.”
It’s important to link up the disciplines, but when the system is broken, we’re not providing coordinated care management. “At the moment, we still live in quite separate disciplines. In some regions it may be better than others, but we don’t have a systemic integrated way of working,” says Jane.
Some countries and societies have naturally done better with healthy ageing. “I think it’s probably correct to say that some of the Nordic countries have a different set of values that they live by, and their tax system gives rise to different opportunities.”
In Denmark, for example, the fundamental mode of transport is bicycles. That gives rise to a healthier population just by the mere fact that that’s a normal way of living.
“In Perth, Western Australia, you wouldn’t see that,” says Jane. “I think with societal change and the generations to come, we may see these. It’s an investment in health promotion and prevention across the life course so that older people will be healthier, which will then reduce the burden on the healthcare system.”
What does an age-friendly environment look like? It’s an environment that’s not only physically accessible, but emotionally and psychologically accessible to all people with a focus on older people. Ireland is one country that has done an exemplary job. This started about 15 years ago when Ireland was economically broke. What they did initially was cost-neutral, but now money is invested because there’s return on investment, like a decrease in hospitalization.
Ireland’s also the first country that was designated as age-friendly in the midst of the pandemic because of the infrastructure. The government has an age-friendly lens over all their policies.
“They were very quick to respond to specific needs of older people because it’s on their agenda,” says Jane. “That’s what makes an age-friendly environment – it’s not a bench or a park. It’s how they view the policies.”
Other examples of how age-friendly policies have been instituted are public transportation systems that are responsive to specific needs in both rural and remote areas or creative initiatives like a school bus being used for another transportation system when not in use during the day. An age-friendly supermarket is one that’s open at a particular time, only for older people.
In Canada, when it comes to health promotion and prevention, we’ve known for a while what we can do to help ourselves and our community achieve healthy ageing. There are modifiable risk factors for dementia, for example. “They’re food, exercise, nutrition, social isolation,” says Jane. “A sense of novelty is also important – doing different things to stimulate your cognition.”
Now the focus needs to be getting buy-in from people. Or understanding why they can’t buy in because we also need to recognize that there is a growing marginalization in the community. For example, it’s harder for older women, older prisoners, older migrants, older refugees and older LGBTQ2S. “It’s hard for this narrative around healthy ageing to be useful to someone that’s been living on the streets,” says Jane, “so it’s really about getting a balanced approach.”
It’s becoming more widely recognized that older people can make significant contributions to society, especially when they’re in good health, and Jane strongly believes that we can make the world a better place for those that are growing older.
“But to continue making progress, it’s important that we start ‘walking up the hill’ to the end of the Decade of Healthy Ageing,” she says.
And what would that look like? For Jane, it would mean that policies are in place, and a different cohort of activists and advocates would be coming together towards a common agenda.
“It’s also about social justice,” she says. “I would hope that we would have a UN convention on the rights of older people by that stage. That’s been 12 years in the making at the United Nations.”
Although we’re not 100 per cent there yet, when it comes to our understanding and treatment of ageing, Jane is optimistic: “I’m a glass half-full kind of person. Every single moment of the day, we’ve got the opportunity to change someone’s life. That’s the gift I’ve got, and you’ve got. What you say and do could save a life. We just need a joined-up approach of those that are on the same team.”
Words to live – and age – by.
For more info, go to: https://ifa.ngo/
Snapshot:
If you were to meet your 20-year-old self, what advice would you give her?
“Be curious, engage and be engaging, seek and take opportunities to learn from all. Live the values that guide you – grace, honesty, integrity and authenticity. Learning happens every moment of the day, but it also takes courage and humility to gain personal insight and transform it to action that brings everyone along for the journey.”
Who or what has most influenced you and why?
“Both the who and the what have contributed to the person I am today, and it continues. Foundational family values and work ethic, but the courage and freedom to say “yes” when I didn’t have all the skills required. The ability to ask questions, to be vulnerable and respect vulnerability. Gaining insights into how situations are handled by different people. Relationships are the most influential action and entity of life – how to build them, how to grow them and nurture them and how to sustain them.”
What keeps you grounded?
“Life and death, joy and pain, the moment and the silence of living. I take nothing for granted and live with deep humility for the opportunities as well as the challenges that have been offered up to me.”
What are you most grateful for?
“The moment, the experiences, health and wellbeing – belonging, being part of an international community that has a strong sense of family. The world of technology that helps us and hinders us from being connected, the human touch.”
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