Welcome to the first article in this monthly series on aged care, where I will explore current issues to provoke reflection on aged care from a range of perspectives.
As a podiatrist with almost 40 years of practice experience, I know that my views on ageing and the care of older people have changed considerably over this time. My own experience of becoming older provides a very different lens to that which informed my perspective as a new podiatry graduate in 1982.
For the purpose of this series, aged care will be interpreted in the broadest sense. That is, the care of older people in our communities, rather than limiting the conversation to the support provided to older people. To care for someone implies an interest in or a concern for their health and wellbeing.
The link between healthy ageing and functional ability
Here I will focus on:
- The concept of healthy ageing and;
- The interdependence of factors that influence a person’s functional ability.
On this latter point, we need to consider how multiple factors impact an older person’s lived experience, particularly in the context of healthcare.
Podiatrists are in a position of privilege and power in relation to our clients; highlighted when working with older people. An understanding of the relevance of socio-cultural and environmental influences is so important to ensure that we apply an equitable approach to enabling healthy ageing for all our clients.
This line of thinking sits comfortably within the broader context of the World Health Organisation’s (WHO) definition of healthy ageing as ‘the process of developing and maintaining the functional ability that enables wellbeing in older age’.
The key words here, for the purpose of this article, are ‘functional ability’. As podiatrists our purpose is to facilitate a person’s functional ability, which is not solely limited to maintaining mobility.
This also encompasses enabling a person to:
- Meet their basic needs
- Grow and make decisions
- Build and maintain relationships; and
- Contribute to society.
The facets of functional ability
A person’s functional ability is dependent on the interaction between intrinsic capacity and environmental factors. 1 As podiatrists, we are educated to focus primarily on addressing a person’s intrinsic capacity (such as managing a disease process, injury or age-related change) to enable pain-free walking.
How often do we as practitioners, however, spend time discussing with our clients the environmental characteristics which influence their functional ability?
- The built environment
- People and their relationships
- Attitudes and values
- Health and social policies; and
- Systems and services.
Inequities around healthy ageing
If you were asked to consider whether all Australians live in an environment that supports and maintains their mental and physical (intrinsic) capacities you would likely respond ‘no’. This infers that not all Australians have an equal opportunity for healthy ageing.
Yet to ensure an equitable approach with our clients, we have a duty of care to address these perhaps unseen or unspoken socio-cultural and environmental factors which influence their functional ability. Whilst podiatrists may not be able to influence a person’s social environment or their personal characteristics, we should all engage in health promotion with our clients to promote the development and maintenance of healthy lifestyle behaviours.
Following this same line of thinking, it is beneficial to reflect on the WHO’s advice around factors that influence healthy ageing. It reminds us which aspects should be implicit in routine podiatry practice.
Despite such advice, it can be easy to neglect factors that are not immediately apparent in connection to a client’s presentation, especially when faced with the busy-ness of service delivery.