Abstract
The studies about the functioning of the elderly play an important role on what the present knowledge of the demography in the world is. The conceptual aspects of functioning according to WHO and operated by the international classification of functioning (ICF), have been insufficiently addressed concerning its adequate applicability in most countries, hindering the contributions of its operation. The ICF operationalizes a new paradigm of the concepts of functionality/disability, but also in relation to the concepts of health/illness, quality of life and well-being; where social skills, personal skills and physical capacity are emphasized, in a multidirectional and dynamic way, where all its components interact equitably with each other. The authors reflect on the contributions that the ICF can make to the organizational, legislative, and structural needs in terms of aging.
Top1. Introduction
Population aging is one of the world's major demographic and social issues today, with a particularly important framework in the most industrialized and developed societies. Recent changes and prospective population analyses have pointed to unprecedented opportunities and challenges for systems and policies, which must reflect the possibility of individuals remaining autonomous for as long as possible. This trend requires sustained planning for aging populations to ensure that risks are minimized and opportunities are maximized.
Suppose the gains achieved in longevity were the result of the various interventions of Public Health. In that case, it is also expected to be its responsibility the interventions for the challenges ahead regarding the dynamics of aging, whose operationalization should focus on maintaining and promoting the health of older individuals. Numerous documents from international organizations refer to the need to follow this challenge for healthy aging, a process that respects all stages of the life cycle based on the health, participation, and security of individuals, the result of which should be to promote longer and, above all, healthier lives.
Moreover, if this is an interactive process whose changes intersect and are reflected in the lives of individuals, societies, and countries, it will naturally be a process that requires modifications and adaptations at the individual, social, and organizational levels. One of the platforms for exercising Public Health in this context concerns reducing social inequalities in health. This aspect tends to increase with age and, despite encompassing different socioeconomic, behavioral, psychosocial, and genetic factors, the empowerment we provide to individuals in terms of health education may be decisive in minimizing these inequalities.
Knowing these interactions through interdisciplinary research will also be a challenging task for Public Health, whose development must respect the diversity and heterogeneity of older people, the aptitude and accountability of local decision-makers, and a conceptually and dimensionally comprehensive environment that promotes healthy aging.
Along with the demographic transition observed in recent decades resulting from low birth and mortality levels and high longevity, an epidemiological transition has reflected the changing pattern of diseases and causes of death resulting from societal changes that include urbanization, consumption, and lifestyle habits.
Although mortality rates have remained high in developing countries, the global trend points towards an increase in chronic and degenerative diseases, including cardiovascular diseases, oncological diseases, dementias, and diabetes. In the epidemiological context of the elderly population, it is also pivotal to consider the risk for infectious diseases resulting from the senescence of immune and homeostatic functions or the greater interaction of chronic versus infectious comorbidities.
Thus, in the coming years, knowing the mechanisms and components that contribute to changes in the functioning of the elderly population, whether in the absence or the presence of acute or acquired disease, will be a challenge for all areas of knowledge.
For Public Health, this will not only be a determining obstacle for its intervention but also the acceptance to consider the functioning of individuals and populations as an unavoidable variable in its study. This consideration or evaluation is not intended to be complex or extensive, although it does require the possibility of reproducing the limitations in the activities of individuals and quantifying the need for equipment, services, and systems that promote the capacity and performance of these activities. This goal has not been fully achieved, and some weaknesses have been observed in different countries regarding functioning-related variables. Most health surveys or censuses are weak in terms of quantity and the standardization of concepts, the latter being crucial for epidemiological comparison, especially for the early detection of groups or populations at risk.
Nevertheless, adopting the biopsychosocial model operationalized by the International Classification of Functioning, Disability, and Health (ICF) has enabled one to observe positive progress in this difficult, as attested to by the MHADIE (Measuring Health and Disability in Europe) (Leonardi et al, 2010a); (Leonardi et al, 2010b)) and MURINET (Multidisciplinary Research Network on Health and Disability in Europe) (Leonardi et al, 2012) multicentric projects, which concluded globally the need to coordinate and integrate the concepts of functioning/disability at all levels of policy-making and in all sectors.
Key Terms in this Chapter
Barriers: These are contextual factors that, through their absence or presence, limit the functioning and cause disability.
Capacity: This is the activity qualifier and describes the aptitude of an individual to perform a task or action in a standardized environment. this one construct aims to indicate the maximum level of functioning that a person can achieve in a given domain, at a given time.
Functioning: This is a generic term for the functions of the body, body structures, activities and participation. indicates the positive aspects of the interaction between an individual (with a health condition) and its contextual factors.
Disability: This is a generic term for disabilities, activity limitations and participation restrictions. indicates the negative aspects between an individual (with a health condition) and its contextual factors.
Model Of Functioning, Disability And Health: It is a multidimensional and multidetermined model that relates biological, individual and social aspects in the interaction with contextual factors.
Facilitators: These are contextual factors that, through their absence or presence, improve the functioning and reduce the disability of a person. facilitators can prevent an impairment or limitation of activity becomes a restriction of participation, since the actual performance of a stock is improved despite of the person’s problem related to the capacity.
Performance: It is the participation qualifier and describes what the individual does in their usual living environment. as this environment includes a social context, the performance can also be understood as “involvement in a life situation” or “the lived experience”, people in the real context in which they live.
Person-Centered Approach: This model suggests that the patient is the protagonist of his own health and places him in the focus of the intervention, as an active participant in setting priorities and making decisions for care.