Toolkit

Purpose: In 2004, Lesotho introduced a non-contributory Universal Old Age Pension to address intergenerational poverty and ensure their oldest people have access to income. The pension’s budget and monthly allowance have grown steadily since it was first introduced. Between 2015 and 2019, the allowance rose from 500 to 700 maloti, and the share of the social budget allocated to the pension scheme also increased by 19 percentage points, indicating the government’s continued commitment to the oldest citizens of Lesotho. As of 2019, the pension distributes 700 maloti or about $47 USD per month to older persons aged 70 and above who are not receiving another pension.

Outcome: Surveys of pension recipients have found that pensioners lead more financially secure, fulfilling lives. A 2015 survey of 215 pension recipients living in rural areas found that hunger and poverty were halved and that pensioners played an increased role in their communities and families, caring for dependent and orphaned children. Pensioners also contributed to household income, which allowed them to become active participants in household decision-making. However, recipients, particularly in urban areas, have reported that the pension is insufficient to meet all their basic needs. Despite these issues, the Old Age Pension provides evidence that even countries with limited financial resources can implement a non-contributory pension program.

Program Expansion: No

Purpose: To combat feelings of isolation, a peer-to-peer support program, called AgeWell, was piloted in 2014 among 212 older adults—all of whom were socially isolated and/or experiencing health issues—in vulnerable communities near Cape Town, South Africa. Twenty-eight AgeWell participants, called 'AgeWells' and who were mobile and active older adults, were matched with the participants. AgeWells were trained and paid to serve as companions to the participants, as well as to collaborate with their peers in establishing a 'Wellness Plan' for them. AgeWells were also trained to spot early signs of health issues among their peers, as well as to use mobile technology to report any issues with participants to social workers or primary care providers.

Outcome: The AgeWell pilot program was shown to reduce feelings of loneliness and social isolation, and improve mood and well-being among the participant older adults. Training AgeWells to spot early signs of health issues led to overall cost savings and better health outcomes for the participants. However, the AgeWells also benefitted from the program. One AgeWell said, “I am 70 years of age. I didn’t know that I would be able to do something like this, go about and try to soothe people, comfort people, make friendship[s] and improve wellbeing and everything. It gave me a fresh life again.”

Program Expansion: Unknown

Purpose: Sangam Vihar is a large, unauthorized community—with no access to government services—in South Delhi, India. A program was piloted in 2012 in six wards, reaching about 1,800 older adults, that aimed to increase comfortable contact between older adults and police officers in the community, as many older adults had reported feeling unsafe. The police officers personally met older adults, gave them contact information on cards, and created a register of older persons living alone or in need of further support, particularly older men who are experiencing addiction to alcohol. The police officers then began periodically visiting older adults in need of support at their homes.

Outcome: A follow-up survey, conducted four months after the program's implementation, found that more than half of older adults in the program area still had the contact cards given to them by the local police.

Program Expansion: Unknown

Purpose: Chief Kikelomo Laniyonu Edwards founded the Dementia Friends program in 2015 and 2016 to change the way Nigerians think about dementia. She was inspired by the United Kingdom’s Dementia Friends program and used its resources to set up her program in Nigeria. Starting with 21 Dementia Friends 'Champions' in 19 of Nigeria's 36 states, Laniyonu Edwards and the Dementia Friends program staff reached out to village chiefs and respected elders across the country. Each Champion was tasked with delivering informational sessions in their community, as well as expanding the program by recruiting 100 'Dementia Friends' each.

Outcome: The original 21 Champions have (by 2017) recruited 80,000 new Dementia Friends, which has expanded the program across Nigeria. His Imperial Majesty, Oba Saliu Olasupo Adetunji, The Olubadan of Ibadanland, became the Grand Patron of Dementia Friends Nigeria in 2016 and has hosted awareness-raising events in honor of the program.

Program Expansion: Yes, the global Dementia Friends organization has implemented similar programs in 15 countries.

Purpose: Alexandre Kalache, Preisdent of the International Longevity Centre, Brazil, piloted the Porteiro Amigo de Idoso (Doorman Friend for the Elderly) initiative in Copacabana, a wealthy neighborhood of Rio de Janeiro, following a series of focus groups with older adults in which they noted that their closest social contact was often the doorman to their apartment building. With the aim of supporting the independence, autonomy, safety, and mobility of older adults living alone in urban centers, Porteiro Amigo de Idoso offers free training to doormen in age-friendly practices, including welfare checks, fall prevention, accessibility, and first aid.

Outcome: Since 2010, the program has trained over 6,000 doormen around Brazil. Older residents living in buildings with trained doormen report feeling safer and having an increased respect for the profession.

Program Expansion: Yes, training is now available in all major Brazilian cities.

Purpose: Despite having a low level of homelessness, as well as a relatively small population of older adults at only 2.5 percent over the age of 60, the Emirate of Sharjah in the United Arab Emirates implemented an innovative program in 2012 to ensure access to affordable, adequate housing for older persons. The program is arranged around three main services for older adults: 1) building a housing unit adjacent to an older person’s family, 2) building an entirely new house for an older adult and their extended family, tailored to the older adult’s needs, and 3) maintaining and modifying existing properties to support the needs of older persons, such as adding an elevator.

Outcome: While the housing units were completed, the Directorate of Housing provided temporary housing for older adults living in challenging conditions.

Program Expansion: Unknown

Purpose: Launched in 1998, Singapore's public housing apartments for older persons (those 55 years old and older) respond to the needs of an aging population. The apartments come built with safety features for older persons and can be customized for living with family or independently. Beginning with studio apartments for seniors in 1995, the Housing and Development Board then expanded its offerings for seniors in 2015 and began to offer a '2-Room Flexi Scheme' that promotes flexibility in lease length. Seniors can choose what length of lease they need as long as the lease covers the older person or couple up to age 95. Additionally, Singapore's fourth 'Remaking Our Heartland' program is aimed at rejuvenating aging housing stock—much of which was built in the 1940s and 1950s—and ensuring that the country's entire public housing stock is world-class quality and accessible to all, within a 20- to 30-year period.

Outcome: Singapore's Housing and Development Board manages about 10,000 apartment blocks and 1 million individual apartments, in which about 80 percent of the country's population lives. Over 90 percent of those who live in public housing own their own apartments. The Housing and Development Board focuses on ensuring that public housing is up-to-date and serves the needs of all people, including older adults, as well as provides community-building social amenities, environmentally-sustainable housing options, and affordable housing options for all citizens. There are also priority schemes for those who plan to live in multi-generational households or for older adults who wish to move closer to their adult children. Another scheme promotes aging-in-community by allowing older persons to buy an apartment that is adapted for senior living, as long as it is within 4 kilometers of their existing apartment. In 2020, Singapore also introduced its first assisted living facilities for older people, which would include health checks, 24 hour emergency care as needed, and simple home fixes, as well as optional services like meal delivery and caregiving.

Program Expansion: Unknown

Purpose: Alphabet's Calico Labs is a biotech company dedicated solely to the science of aging, in the hope of expanding societal understanding of aging and potential interventions to increase lifespan, conducting research in-house, and awarding grants with few restrictions on research focus. Current areas of research include automation, genome and genetic mapping, and the development of non-invasive imaging technologies for preventive care. Calico has also partnered with a major pharmaceutical company to create drugs targeting diseases associated with old age. The enterprise is one of several experimental research centers funded and coordinated by Google and its parent company, Alphabet.

Outcome: As one of Alphabet's more experimental enterprises, information on impact and outcomes is limited.

Program Expansion: No

Purpose: The UK Research and Innovation’s 'Healthy Ageing Challenge' is a public-private partnership that aims to support healthy aging in the UK. The Healthy Ageing Challenge will provide up to £40 million in funding for large-scale 'trailblazer projects' on healthy aging; £2 million for social, behavioral, and design research; and £4 million for social enterprises, in partnership with the UK’s Small Business Research Initiative.

Outcome: Supporting the Healthy Ageing Challenge are five private sector ‘investment partners’ that will collectively provide up to £39 million in grant funding over a three-year period for small- and medium-sized enterprises (SMEs) to develop innovations for healthy aging. The investment partners are:

• Nesta, a UK-based impact investor that provides investment for social interest organizations across several sectors—health, education, food, climate, and the future of work and productivity. Nesta will commit up to £6 million to the Challenge.
• Northstar Ventures, a venture capital firm focused on entrepreneurs with innovative ideas across a range of sectors in the North East of England, will commit up to £3 million specifically for SMEs undertaking research and development projects.
• 24Haymarket, a venture capital firm that connects high-net-worth individual or family investors to its network of promising small-scale entrepreneurs, will contribute to grant funding for new and growing SMEs.
• Barclay Ventures, a business incubation lab started by Barclays Bank, will match funding for grants focused on health technology.
• Legal & General, the UK’s largest life insurance company, will contribute £6 million to SMEs focused on reducing the cost and occurrence of aging-related illnesses.

Program Expansion: Unknown

Purpose: Japan Post, the country’s national postal service, began to provide its 'Elderly Watch Service' in 2013 in its pilot area of six prefectures. By early 2015, the program enabled postal service workers to check in on elderly people for a monthly charge of Y1,000 ($8.40). Elderly persons and their families can subscribe to receive one 60-minute home visit or daily phone check-ins for a monthly fee.

Outcome: Yes, throughout the entire country.

Program Expansion: Yes, the program was expanded nationwide in the second half of 2015.

Purpose: The Radars project was first piloted in Barcelona, in the Camp de Grassot neighborhood, with the aim of supporting older adults to live independently for as long as possible, and to combat social isolation. Radars is a model for aging-in-community, as it engages the local community in caring for the older people in their midst. Two-fifths of Spaniards over the age of 85 live alone, and shops, pharmacies, and cafes are often their main sites of social interaction. In response, the Radars project mobilizes shopkeepers, cafe owners, and any other interested citizens to form relationships with older adults and watch out for their needs. If a volunteer, called a 'Radar', is concerned about someone's health, or potential elder abuse, they can call the social services hotline, and a professional will be dispatched to the relevant residence to perform a check-in. Radars volunteers also organize social activities to combat social isolation.

Outcome: The initiative has been expanded across the entire city and now operates in 55 Barcelona neighborhoods.

Program Expansion: Yes, in 2012, across Barcelona.

Purpose: Former United States Secretary of State Hillary Clinton called for the creation of the Data2X initiative in 2012, and the Initiative was established in 2014. The UN’s Data2X initiative, while not focused on aging and older populations, acts as a repository for gender-disaggregated data sources from around the world, and regularly calls on public- and private-sector institutions to improve their collection of gender-disaggregated data.

Outcome: Data2X has established partnerships with the private sector, academics, government agencies, and multilateral agencies to encourage harmonization in and disaggregation of data collection. Data2X also taps into 'big data' and attempts to make sure that large-scale data ecosystems have a gender component, in order to better understand the needs of women and girls across their lives.

Program Expansion: Data2X facilitates partnerships with data-producing institutions.

Purpose: China’s Design Code for Buildings of Elderly Facilities was established by the Ministry of Construction (now named the Ministry of Housing and Urban-Rural Development) and the Ministry of Civil Affairs in 1999.

Outcome: The code applies to roads, buildings, and other public places in China to ensure they are accessible for older people, aiding the goal of aging-in-community. The code applies for any building that older people access regularly across the country and runs across 30 criteria under 5 categories.

Program Expansion: Similar codes have been established in other countries, including Malaysia, Mexico, and Australia.

Purpose: The California Master Plan for Aging is a government-led, multi-stakeholder approach to promoting healthy aging for the entire community. The Plan lays out goals for public- and private-sector health institutions to attain through program implementation, focusing particularly on improving services for older adults from vulnerable groups, such as people of color and unhoused individuals. It was designed following extensive civil society engagement with older adults: The SCAN Foundation conducted polling work among older adults in California and found that, regardless of party affiliation, voters wanted the state government to design a plan to address population aging. While it has many components, the Plan is structured around five goals:

1. Housing for All Stages & Ages: safe, appropriate, and affordable housing for all Californians;
2. Health Reimagined: closing the health equity gap and increasing life expectancy;
3. Inclusion & Equity, Not Isolation: protecting older adults and their carers from abuse, neglect, and discrimination;
4. Caregiving that Works: improving the quality of jobs for caregivers; and
5. Affording Aging: ensuring economic security for older adults.

Outcome: While the Master Plan is in the early stages of implementation, the state government has implemented an Indicator Progress Dashboard, where stakeholders in healthy aging will be able to track the progress made toward each goal and component sub-strategy.

Program Expansion: Unknown

Purpose: The Experience Corps program was established in Baltimore in 1995, which connected older adult volunteers with elementary school-aged students in struggling and/or under-resourced public schools. The program serves as a space for inter-generational interaction through volunteer tutoring, particularly around reading and literacy skills. Volunteers provide between 6 and 15 hours of support in classrooms per week.

Outcome: The current iteration of the Experience Corps program serves over 9,600 students every year in elementary schools and has more than 2,300 highly-trained volunteers working in 23 cities. Now expanded to 23 U.S. cities and facilitated by AARP, independent evaluations of the program found that older adult volunteers helped over half of Experience Corps students to make favorable changes in their inter-personal relationships, self-control, and reading proficiency over time. Experience Corps is an important program because it works to connect three stakeholder groups—older people, who can find meaning in working with children; children in high-need elementary schools, who can better understand older generations by working closely with them; and both of those groups with the wider community, which benefits by fostering inter-generational connections.

Program Expansion: Yes, in 23 cities across the United States, through AARP.

Purpose: In 2021, the Centre for Better Ageing launched a free library of stock images of older people intended to challenge negative and stereotypical views of aging. The images are 'positive and realistic', providing a diverse representation of aging and later life across a number of themes including health, community activity, and employment. The Centre created the library following their research on ageism, which found that stock image libraries often publicize unrealistically positive or negative depictions of older adults—they also intend to create a series of 'age-positive icons' designed in consultation with older adults, and intended to replace icons and symbols used on street signs and websites.

Outcome: While the project is still relatively new, in March 2021 the Centre partnered with Pexels, one of the largest free stock image libraries in the world, to expand its range of age-positive stock imagery, growing the library from 400 to over 700 photos.

Program Expansion: Yes, in March 2021, the library was expanded from 400 to over 700 photos.

Purpose: The Buenos Aires city government's Proteger program is intended to reduce instances of elder abuse and provide support for victims. In addition to a hotline that abused individuals or concerned citizens can call for help, the program offers emotional counselling, legal support, and temporary housing to victims of abuse. Older adults can also join the 'Social Defenders' initiative, where they receive training in how to identify signs of abuse, and are encouraged to sensitize their peers and the wider community on issues related to elder abuse and the available resources.

Outcome: Between 2000 and 2018, Proteger helped over 86,000 older adults in Buenos Aires.

Program Expansion: No

Purpose: During the height of the Ebola outbreak in Liberia in 2014, sixteen registered NGOs formed the Coalition of Caregivers and Advocates for the Elderly in Liberia (COCAEL), in response to the invisibility of older persons in the Liberian government’s Ebola strategy. The strategy neglected to name older persons as a vulnerable group, while identifying women and children as being at risk. COCAEL launched advocacy campaigns to bring older people’s needs to the forefront of the public conversation and formed the COCAEL Ebola Response Committee, which solicited donated funds and items to provide food and educational materials focused on awareness and prevention of Ebola to older Liberians, particularly those in residential care settings.

Outcome: COCAEL continues to mainstream the needs of older adults, including by leading celebrations of World Older People Day in Liberia for the first time. In 2020, COCAEL launched a national Older People Stay-At-Home Campaign. In 2021, COCAEL participated in the consultation process for a legislative bill creating a new National Commission for the Elderly in Liberia (NCEL), intended to address the needs of older adults in Liberia.

Program Expansion: N/A

Purpose: The Ibasho model is designed to facilitate the social integration of older adults in their local communities and to reduce their vulnerability during and after natural disasters. The first Ibasho project developed following the 2011 Great East Japan earthquake, in Ofunato, Japan. Older adults in the community wanted to contribute to the recovery process, and worked with implementing partners to create the 'Ibasho cafe,' where they interact with younger generations through literacy programs, a day care center for children, a noodle shop, and a kitchen garden—the profits from these programs are re-invested in the cafe, making it financially self-sustaining. The model facilitates intergenerational learning and socialization, which strengthen ties between older adults and the surrounding community, while addressing unique local needs.

Outcome: In the first three years of the Ofunato Ibasho cafe's operations, it hosted around 500 events and hosted more than 18,000 visitors. Ibasho models have been established following natural disasters in Nepal, the Philippines, and Cote d'Ivoire, where local older adults are empowered to identify the most appropriate activities for the needs of their community.

Program Expansion: Yes, Ibasho projects have been established in Nepal, the Philippines, and Côte d'Ivoire.

Purpose: The 'age-friendly' label for cities and communities was first established by the WHO in 2007 and expanded into the WHO Global Network of Age-Friendly Cities and Communities (GNAFCC) in 2010. Members of the GNAFCC are committed to the creation of cities that are nurturing places in which to age, foster the full participation of older persons in community life, and promote healthy and active aging. The Network connects cities and communities working toward these goals to share knowledge and experience, supports those communities to find and implement appropriate solutions to age-related challenges, and aims to inspire change by encouraging other communities to make the same commitment. The WHO also hosts a database of age-friendly practices, based on an agreed framework, helping to establish a shared understanding of 'age-friendliness.'

Outcome: The WHO Global Network of Age-friendly Cities and Communities now includes 1,114 age-friendly cities in 44 countries, serving a population of over 262 million people worldwide.

Program Expansion: Yes, to over 1,114 age-friendly cities in 44 countries.

Purpose: Egypt's Decent Life initiative was launched in 2019 in 375 villages as part of a nationwide effort to achieve sustainable development in rural areas, led by the Ministry of Planning and Economic Development. The initiative as a whole focuses on poverty reduction and increasing access to basic services and infrastructure. Of particular relevance to older adults in the country is the Regular Medical Caravans project—mobile medical clinics that provide free medical consultations and services, including minor surgeries, to rural communities. Studies predict that, while the country as a whole is aging steadily, rural communities will age at a faster rate than urban ones, due in large part to rural-urban migration of young adults, and a trend of out-migration to rural areas after retirement.

Outcome: In 2021, President Abel Fattah Al-Sisi announced the expansion of Decent Life to a total of 1,500 villages, reaching an estimated 20 percent of the national population. As part of this expansion, the Regular Medical Caravans project will be expanded with the help of the Ministry of Health and Population.

Program Expansion: Yes, to over 1,000 additional villages in Egypt.

Purpose: As part of a multi-stakeholder push to improve quality of life and health care for older adults in Jordan, HelpAge International partnered with the National Council for Family Affairs (NCFA) in 2020 to hold a series of focus groups and advocacy exercises aimed at identifying the needs and wants of older adults. The focus groups, held in the cities of Amman and Zarqa, highlighted the need to create older adult day centers to encourage social interaction, and to support retired older adults to remain engaged in society and productive work for as long as they want.

Outcome: Recommendations developed as a result of the focus groups have been passed on to the Jordanian Ministry of Health for implementation, in line with the country's National Strategy for Senior Citizens.

Program Expansion: HelpAge recommends that governments and program implementers conduct focus groups with older adults in target communities.

Purpose: The New York City Health + Hospitals public care system recently launched a 'Medical Eracism' project, which takes a systematic approach to eliminating medical racism across the city’s health care infrastructure by identifying and discontinuing medical tests and assessments that are based on biased and inaccurate assumptions about racial difference, particularly the erroneous idea that race is a biological determinant, rather than a social construct. The project therefore aims to improve the standard of care offered to people of color by testing and treating patients equally, and addressing the social determinants of health. Improving standards of care for people of color will help to reduce inequities and disparities that grow throughout a person's lifespan, promoting health at all ages and contributing to the healthy aging of older adults of color.

Outcome: Since May 2021, the initiative has identified two common diagnostic tests that made use of race-based calculations for severity of illness and risk, leading to implicit bias among medical providers and the potential for errors in diagnosis and treatment. The glomerular filtration rate (eGFR) kidney function calculation and the Vaginal Birth After Caesarean-section (VBAC) risk assessment have both been eliminated from the NYC Health + Hospitals system.

Program Expansion: Unknown

Purpose: The Maseru Women Senior Citizens Association (MWSCA) was founded in 1997 by a group of 10 older women, with the aim of encouraging healthy and active aging and combating discrimination and abuse of older adults in Lesotho. At the time, the government provided few services and resources targeted specifically at the older population of Lesotho. The group acts as both an advocacy organization and a service provider, running educational programs on issues concerning older people, including HIV/AIDS prevention and treatment; distributing food, seeds for crops, and clothes; and helping to pay school fees.

Outcome: MWSCA continues to operate in Lesotho, including on a project to improve training for domestic caregivers. It is currently the only national NGO focused on the needs of older adults.

Program Expansion: N/A

Purpose: The first Older People's Associations (OPA) were established in the Cambodian provinces of Battambang and Banteay Meanchey, following the country's civil war, to support vulnerable older adults in a fragile context and to fill gaps in social support and service delivery caused by the conflict. OPAs are membership-based community organizations that empower older people to help each other and themselves through advocacy, peer-to-peer support, and service delivery on a local level. HelpAge International—and now the government of Cambodia—supports these groups by providing funding and micro-loans, including small business grants, connecting them to services such as home-based care, and delivering civic engagement and advocacy training.

Outcome: There are now OPAs established in every province of Cambodia, with over 300,000 members, as of 2019. During the COVID-19 pandemic, OPAs have provided vital support to older adults, particularly by disseminating information on disease prevention and vaccinations, as many rural dwellers do not have access to the internet. As vaccinations have become available in Cambodia, HelpAge has distributed small transport grants to local OPAs to help the poorest older adults travel to nearby clinics, leading to an estimated 500 people getting vaccinated.

Program Expansion: As of 2020, there were OPAs active in an estimated 89 countries worldwide.

Purpose: The Disrupt Aging Collection was launched in 2019, with an initial library of over 1,400 images selected to demonstrate a more accurate portrait of aging. The Collection is a response and corrective to how people over age 50 are often portrayed in the media: as dependent or socially isolated, an assumption that can lead to ageism and obscures the diversity of experiences of older adults. The Collection includes photos showing older adults at work, with their families, and pursuing hobbies, for example.

Outcome: As part of the Disrupt Aging Initiative, AARP has held events and activities at media and advertising events such as Advertising Week New York, and SXSW festival.

Program Expansion: Unknown

Purpose: India's Senior Citizens Act 2011 includes policies specifically targeted at vulnerable subgroups within the country's older population, particularly rural dwellers and women. The Act seeks to address aspects of the phenomenon of feminization-of-aging, by recognizing older women's increased likelihood of living in poverty in old age and suffering from chronic illness, non-communicable disease, and disability in later life. Over 50 percent of Indian women over age 80 are widows, which can leave them vulnerable to social isolation and make it hard for them to access social services, health care, and elder care. In recognition of these inequities, the Act ensures that single women and widows—including those aged over age 85, the so-called 'oldest old'—can access all available government assistance, including social pensions. Additionally, the country's 12th Five Year plan (2012–17) implemented awareness-raising campaigns around diseases that are more prevalent among older women, including breast cancer. The government also provides tax incentives and counselling services for informal family caregivers, who are usually women.

Outcome: An early analysis of social pensions for widows in India found that they reduce poverty among recipients by 2.7 percentage points. However, social pensions, like many forms of government assistance in India, suffer from low uptake, likely as a result of illiteracy, particularly among older women.

Program Expansion: N/A

Purpose: Uruguay's Integrated National Care System (SNIC) was introduced to address the country's growing caregiving crisis, reduce gender inequality, and guarantee high-quality care for all children, people with disabilities, and older adults. The intention is to integrate and coordinate formal and informal caregiving, sharing responsibilities among family, governments, the local community, and the economic marketplace. The system has three core dimensions:

1. Care provision for children under three years of age, including day care provision in all public institutions, and extensions of paternal and parental leave policies;
2. Care services for older adults and people with disabilities, including access to personal assistance, day care centers, long-term residential institutions, and the extension of telehealth services; and
3. The professionalization of the paid care work force, including expanded training opportunities and a certification process.

Outcome: The coordinating authorities report that between March 2019 and 2020, over 6,100 older and disabled people were connected to personal care assistance, and over 4,600 people were employed as care assistants. In March 2020, telehealth services were used by around 1,500, and day care centers by over 200 people.

Program Expansion: N/A

Purpose: The 'Four Ms' is an age-friendly framework for simplifying and streamlining health care for older adults by identifying four key areas that drive effective health care decision-making, with the aim of promoting health and wellness, as well as preventing disease. The framework was developed and introduced by the Institute for Healthcare Improvement (IHI), in partnership with several American hospital and health associations, and funded by the John A. Hartford Foundation.

The 'Four Ms' consist of:

• What Matters: Outlining and adhering to individual older adults’ specific health goals and care preferences, including end-of-life care, based on their priorities;
• Medication: Where possible, ensuring that any necessary medication does not interfere with older adults’ health goals, mobility, or cognitive function, to preserve quality of life;
• Mentation: Promoting cognitive function by preventing, identifying, treating, and managing dementia, depression, and delirium;
• Mobility: Ensuring that older adults can move safely throughout their daily lives to maintain function and do 'what matters' to them.

Outcome: As of August 2021, the IHI had recognized over 2,400 hospitals and health care practices as Age-Friendly Health Systems utilizing the 'Four Ms' around the world.

Program Expansion: Yes, the 'Four Ms' program has been expanded to over 2,400 hospitals and health care practices.

Purpose: The Maldives' Ministry of Gender and Family launched the nationwide 'Ranveyla' Campaign in 2016, in order to monitor the health and well-being of senior citizens. While each atoll in the Maldives had different policies implemented, according to its population's needs, the campaign was particularly focused on promoting the rights and health of older persons through awareness and training programs, as well as mainstreaming a focus on older persons' needs across all sectors of society, such as health care providers, schools, and police.

Outcome: Each Atoll had different programs implemented, according to the needs of its elderly population. Across a year of implementation, 178 older adults (over age 65) in Lhaviyani Atoll, for example, had their blood pressure, Body Mass Index (BMI), and blood sugar levels monitored, in partnership with the Lhaviyani Atoll Hospital and other local health centers. Local health care providers and social workers also completed training during a two-day workshop in order to better care for the needs of older persons, and 120 older persons participated in educational seminars on elder care and community participation. There were also sessions focused on building intergenerational ties between youth and older adults in Lhaviyani Atoll. The Campaign as a whole also inspired the drafting of the country's first 'National Elderly Policy' in 2017, after consultation with stakeholders and information-gathering about the country's elderly population that took place during the Campaign. The National Elderly Policy, which was formally ratified in 2018, is formulated along four key themes: 'care and protection,' 'independence and participation,' ' health and wellbeing,' and 'preparation for old age.' Following the Policy, a National Elderly Action Plan (NEAP) was formed in 2019 to put the principles of the Policy into action. As of 2021, the country was undergoing a nation-wide assessment of its elderly population's needs and experiences.

Program Expansion: Yes, throughout the entire country.

Purpose: Ireland’s Let Me Decide Advance Care Planning and Palliative Care Programme integrates palliative care and long-term care, providing expanded access to palliative care that prioritizes the preferences and needs of older people. The pilot allowed patients in six Irish LTC (five nursing homes and one hospice) facilities to establish end-of-life directives, including for palliative care, and 90 medical staff across the facilities were trained in palliative care techniques.

Outcome: During the three-year implementation period, there was a dramatic increase in palliative care services uptake among LTC residents—from 25 percent before the program to 76 percent during the program—which suggests that palliative care is attractive to older adults if it is offered as a viable option. There were also precipitous drops in hospitalization rates, in-hospital time, and in-hospital deaths, compared to the baseline. The program also lowered costs and improved quality of hospitalization, death, and dying in the nursing homes as compared to hospitals. The estimated cost savings from the reduction in hospital resources used, if the program were expanded throughout Ireland, could reach €17.7 to €42.4 million nationally.

Program Expansion: A similar program is being piloted in Portugal.

Purpose: The Community Aging in Place, Advancing Better Living for Elders (CAPABLE) program aims to reduce the impact of disability among low-income older adults by addressing individual capacities and the home environment. The program deploys a three-person team consisting of a registered nurse, an occupational therapist, and a handyman to support participants set and achieve goals around activities for daily living and personal mobility. This inter-professional team provides assistive devices, makes home repairs, and modifies living spaces to enable participants to navigate their homes more easily.

Outcome: In its initial pilot period between 2012 and 2015, 281 people aged 65 and over, who were dually eligible for Medicare and Medicaid, were admitted to the program. All 281 had difficulty performing basic activities required for daily living (ADLs), such as cooking or bathing. After completing the five-month program, 75 percent of participants saw an increase in functional ability, including ADLs, and the ability to grocery shop and manage medications. Symptoms of depression decreased, and participants reported improved motivation. The program cost roughly $3,000 and is estimated to have saved nearly $20,000 in medical costs across all participants, due to reductions in inpatient and outpatient expenditures.

Program Expansion: N/A

Purpose: The Middle East Academy for Medicine of Ageing (MEAMA) is a dedicated geriatric training and educational hub serving the entire region. The aim of MEAMA is to boost the number of health care professionals with training in geriatrics. The academy is run by a group of volunteer geriatricians from the region and Europe that run short courses and conferences for health care professionals. MEAMA hosts a two-year postgraduate course that consists of four geriatric training courses lasting a few days every six months. Most courses take place in Lebanon, delivered in Arabic.

Outcome: In total, an estimated 800 students have gone through the course.

Program Expansion: Yes, the gerontology program is now offered in Tunisia in French.

Purpose: HelpAge International partnered with local NGOs and national governments to deliver better health outcomes and reduce poverty among older people in Ethiopia, Mozambique, Tanzania, and Zimbabwe. The project included geriatric and noncommunicable disease (NCD) training for health professionals, home-based and family caregiving training, community-based training for health workers and volunteers, the development of older people’s associations, the development of curricula for medical schools, and the development of surveys of older persons to monitor accessibility and satisfaction with health services.

Outcome: While the program was not continued in the four original implementing countries, over the initial implementation period, the program increased the number of health facilities from 18 to 149 across the four countries. The program also trained 1,326 home-based caregivers and 2,074 health professionals in geriatric and noncommunicable disease (NCD) care. It also successfully changed the medical school curriculum to include education on geriatric care and NCDs in Tanzania. In Ethiopia, the program’s success inspired some hospitals to set up specialist NCD clinics. It also inspired the Ministry of Health to roll out its own training on NCDs and geriatric care, following the success of the program.

Program Expansion: Yes, in 2018, the German government provided additional funding to HelpAge International to continue the program in Tanzania.

Purpose: iN2L is a technology company that develops tablets and touch-screen devices to support older people’s independence and cognition. The system provides access to more than 4,000 content items and social media. The tablet also includes a dementia care interface, which is organized into categories such as 'reminiscence,' 'entertain,' and 'stay connected.' This dementia care interface was designed in collaboration with target users. Product developers worked iteratively, testing each new idea and development on a focus group of older adults with dementia to ensure that it met their needs and was usable by people with a range of digital literacy and mobility abilities. The system also allows the user to create custom grouping of applications and place them under icons for a specific resident or staff member.

Outcome: iN2L tablet usage among people with dementia has been found to increase resident engagement with others and satisfaction with care. Tablet usage is also associated with improved physical performance and increased mental stimulation.

Program Expansion: N/A

Purpose: Active Ageing Centers and Active Ageing Care Hubs are drop-in centers for older persons in Singapore, providing a space for older adults living nearby to socialize and receive care. The hubs provide a range of preventative, rehabilitative, and promotive health care services, in addition to community activities. Some of the health and care services offered include day care, dementia care, rehabilitation, home health services, fall risk and wellness screenings, and mental health services. These hubs are created in partnership with local grassroots organizations, health care providers, and corporations and are staffed by both by professionals and volunteers. The hubs also act as information and referral points for older adults who need additional support or government services.

Outcome: There are a total of nine centers and hubs across the island. The hubs have been heralded as a great success by Singapore’s government. At the Ageing Hub located in the Kampung Admirality, which is an innovative, age-friendly public housing development for older people, one in five residents uses the Active Ageing Hub located in the building. Another hub located in Bedok is estimated to have helped more than 32,000 older persons over three years.

Program Expansion: Yes, additional hubs have been added since the initiative began in 2018, and more are planned.

Purpose: Thailand’s Community-based Long-term Care (LTC) Program aims to provide in-home care for homebound and bedridden older adults over 60 years of age. Services provided include coordinated care and in-home visits by home caregivers for up to 8 hours a week, depending on need and availability. Care is provided by part-time volunteer and paid caregivers from the community, building on a decades-long history of community health volunteerism. Caregivers receive 70 hours of training covering first aid, the rights of older persons, drug administration, and care for critical and chronic conditions. The Thai Community-based LTC Program was inspired by similar programs in Japan.

Outcome: The initial pilot began with a budget of $19 million and a target of 100,000 beneficiaries in 1,000 subdistricts. Since its inception, it has been scaled up annually, providing services to almost 100,000 additional older adults by 2018.

Program Expansion: Yes, the LTC Program has been scaled up annually since its inception.

Purpose: The Danish program aims to promote self-care and mental health among informal caregivers of people living with dementia or other long-term diseases, as many family caregivers develop physical or mental health problems as a result of caregiving. The program conducts weekly interactive training sessions that allow informal caregivers to share experiences and limit social isolation. The session also allows caregivers to learn skills and build resilience to handle stress associated with caregiving.

Outcome: Between 2018 and 2021, the program has been carried out in all 98 municipalities in Denmark. A survey of participants found that the courses were shown to decrease the risk of prolonged stress and depression, as well as increase physical and mental well-among participants.

Program Expansion: Yes, until the end of 2021, municipalities can receive support for the start-up and operation of this program from the Ministry of Health and Elderly.

Purpose: CARE Campus provides online qualitative training courses for professional and family caregivers in Europe. The courses are available in French and English to anyone who signs up. Ten courses are currently available that cover a range of topics, including age-related diseases and disorders, technology and aging, end-of-life caregiving, nutrition, and supporting personal care for older adults.

Outcome: Between 2018 and 2019, nearly 12,000 people registered for the courses. Other projects have been carried out in connection to the courses, including informational events in Paris and Nice in France and Coimbra in Portugal.

Program Expansion: N/A

Purpose: Japan’s long-term care (LTC) insurance provides benefits for the long-term care of persons aged 65 and over, or those over 40 years old with age-related disabilities. LTC services can be accessed by those that are insured and who are certified for support. Once certified, care is delivered according to care needs and coverage includes institutional, home, and community-based services. The insurance scheme covers 90 percent of the cost of services and requires beneficiaries to pay a 10 percent copay. This public program is financed through taxes and premiums, which are paid by all persons aged 40 and over.

Outcome: As of 2019, the program covered more than 60 million people and helped fund long-term care services for nearly six million people.

Program Expansion: N/A

Purpose: The Family Care Allowance Act supports qualifying family caregivers with various services and a monthly allowance paid by the municipal government to the caregiver. In 2021, the allowance or 'care fee' equaled at least €413.45 per month. The law also provides services to support caregiver's well-being and care duties, including training as well as mental and physical health services. The law also establishes caregiver leave, which provides caregivers at least two days off per month. During caregiver leave, the municipality arranges home-based or institutional care for free. To qualify, caregivers must enter into an agreement with the municipality, which requires the consent of the person receiving care.

Outcome: In 2019, approximately 50,600 people received family care support.

Program Expansion: N/A

Purpose: The nonprofit Rand Aid Association builds retirement villages and frail care centers in Johannesburg, South Africa, that emphasize the autonomy and choice of older adults, who can adapt their homes or move into residential care facilities as their health needs evolve. Most of the retirement villages are governed by a 'life rights' model, in which people can choose to buy a life-long right to occupy a unit in the villages, which can be passed on or terminated at will. One of the villages has units that can be rented, rather than bought. Three mornings per week, the Zamokuhle outreach program assists retired persons in three communities in Johannesburg to age-in-place in their homes. The outreach program also facilitates intergenerational connection, provides nutritional support through breakfasts and lunches, and helps older persons understand their rights as elders, among other activities. The Rand Aid Association also supports another organization, called the Joseph Gerard Foundation, to provide frail care by building its capacity and providing meals.

Outcome: As of 2020, the retirement villages and frail care centers collectively housed about 3,000 residents, while the separate frail center supported about 130 patients. Many of the residents of the frail center also have neurocognitive impairment or mental health challenges as well as frailty, and are cared for by a dedicated team of multidisciplinary staff.

Program Expansion: Yes, in 2009, the Rand Aid Association expanded its program from paid retirement villages and long-term care for frail residents to found the Zamokuhle outreach program.

Purpose: Cooperative Home Care Associates (CHCA) is the United States' largest worker-owned cooperative for professional caregivers, with over 2,000 employees. CHCA aims to provide high-quality home-based care, largely to older adults covered by Medicare and Medicaid, through the creation of well-paid, stable caregiving jobs. Cooperative staff go through a four-week initial training course, and receive a starting salary of $15 per hour, medical and dental benefits, paid time off, and the ability to buy into the cooperative and receive annual dividends and voting rights. CHCA also offers free training to 600 low-income women of color annually.

Outcome: CHCA has grown from an initial staff of 12 home care aides to over 2,000.

Program Expansion: Yes, in 2019, CHCA partnered with Independence Care System, a local NGO, to offer step-up training for care workers who wish to become care coordinators—a more advanced qualification that can act as a pathway to further training.