Framework for integrated community-based life-long health and care services in aged societies

IWA 18:2016 provides guidelines for addressing challenges faced by societies that have been unable to adapt to an ageing population. It can also be used by stakeholders as a useful reference at regional or global level. IWA 18:2016 addresses health, care and social challenges (including health care needs, daily living tasks, well-being, combating isolation and keeping safe) to ensure that the needs of individuals continue to be met as they grow older. It also outlines principles related to ethics, community-based solutions, integration, person-centred solutions and innovation.

Cadre de travail pour les services de santé et de soins communautaires à vie intégrés dans les sociétés âgées

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Published
Publication Date
08-Jun-2016
Current Stage
6060 - International Standard published
Start Date
21-Mar-2016
Completion Date
09-Jun-2016
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INTERNATIONAL IWA
WORKSHOP 18
AGREEMENT
First edition
2016-06-15
Framework for integrated community-
based life-long health and care
services in aged societies
Cadre de travail pour les services de santé et de soins communautaires
à vie intégrés dans les sociétés âgées
Reference number
IWA 18:2016(E)
ISO 2016
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IWA 18:2016(E)
COPYRIGHT PROTECTED DOCUMENT
© ISO 2016, Published in Switzerland

All rights reserved. Unless otherwise specified, no part of this publication may be reproduced or utilized otherwise in any form

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ii © ISO 2016 – All rights reserved
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IWA 18:2016(E)
Contents Page

Foreword ........................................................................................................................................................................................................................................iv

Introduction ..................................................................................................................................................................................................................................v

1 Scope ................................................................................................................................................................................................................................. 1

2 Terms and definitions ..................................................................................................................................................................................... 1

3 Principles and social issues ...................................................................................................................................................................... 5

3.1 Principles ..................................................................................................................................................................................................... 5

3.1.1 General...................................................................................................................................................................................... 5

3.1.2 Human dignity ................................................................................................................................................................... 5

3.1.3 Productive ageing ............................................................................................................................................................ 5

3.1.4 Community-based services ..................................................................................................................................... 5

3.1.5 Systemization with people at the centre ..................................................................................................... 5

3.1.6 Pursuit of innovation for sustainability ....................................................................................................... 6

3.2 Social issues ............................................................................................................................................................................................... 6

3.2.1 General...................................................................................................................................................................................... 6

3.2.2 Future provisions for aged societies ............................................................................................................... 6

3.2.3 Challenges and barriers to creating new approaches...................................................................... 9

3.3 Basic approach .....................................................................................................................................................................................10

3.3.1 Health and care in relation to ageing ..........................................................................................................10

3.3.2 Healthy ageing ................................................................................................................................................................12

3.3.3 Approaches to ageing, implementation and services ...................................................................13

3.3.4 Guidance for maintaining the quality of services .............................................................................16

4 Holistic framework of services ...........................................................................................................................................................18

4.1 General ........................................................................................................................................................................................................18

4.2 Integrated health services ..........................................................................................................................................................18

4.3 Integrated care services ...............................................................................................................................................................21

4.4 Social infrastructure ........................................................................................................................................................................23

5 Recommendations ...........................................................................................................................................................................................25

Annex A (informative) Workshop contributors .....................................................................................................................................26

Bibliography .............................................................................................................................................................................................................................29

© ISO 2016 – All rights reserved iii
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IWA 18:2016(E)
Foreword

ISO (the International Organization for Standardization) is a worldwide federation of national standards

bodies (ISO member bodies). The work of preparing International Standards is normally carried out

through ISO technical committees. Each member body interested in a subject for which a technical

committee has been established has the right to be represented on that committee. International

organizations, governmental and non-governmental, in liaison with ISO, also take part in the work.

ISO collaborates closely with the International Electrotechnical Commission (IEC) on all matters of

electrotechnical standardization.

The procedures used to develop this document and those intended for its further maintenance are

described in the ISO/IEC Directives, Part 1. In particular the different approval criteria needed for the

different types of ISO documents should be noted. This document was drafted in accordance with the

editorial rules of the ISO/IEC Directives, Part 2 (see www.iso.org/directives).

Attention is drawn to the possibility that some of the elements of this document may be the subject of

patent rights. ISO shall not be held responsible for identifying any or all such patent rights. Details of

any patent rights identified during the development of the document will be in the Introduction and/or

on the ISO list of patent declarations received (see www.iso.org/patents).

Any trade name used in this document is information given for the convenience of users and does not

constitute an endorsement.

For an explanation on the meaning of ISO specific terms and expressions related to conformity assessment,

as well as information about ISO’s adherence to the World Trade Organization (WTO) principles in the

Technical Barriers to Trade (TBT) see the following URL: www.iso.org/iso/foreword.html.

International Workshop Agreement IWA 18 was approved at a workshop hosted by the British Dental

Association (BDA), in association with the British Standards Institution (BSI), held in London, United

Kingdom, in July 2015.
iv © ISO 2016 – All rights reserved
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IWA 18:2016(E)
Introduction

This International Workshop Agreement defines principles, social issues and approaches related

to aged societies in order to address the shortcomings in social infrastructure. The contents of this

International Workshop Agreement, which are supported by the holistic framework of services (see

Clause 4), need to be highlighted on a global platform in order to share knowledge. Countermeasures

to cope with insufficiencies in social infrastructures to adapt to a global ageing society need to be

addressed today.
[3]

According to projections based on the UN DESA report on World Population Prospects by the year

2050, many countries are projected to become super-aged societies, with people aged 65 years or older

exceeding more than one in five of the population.

NOTE The terms “ageing society” (where more than 7 % are 65 years or older) and “aged society” (where

more than 14 % are 65 years or older) are derived from past UN population reports. The term “super-aged

society” (where more than 21 % are 65 years or older) is an extension of these terms. It is used in the academia

and government of Japan and is gradually spreading into use in international news arenas.

In addition, developing countries and regions with rapid economic growth will be subject to changes to

their ageing population over the next few decades. A well-supported infrastructure of an aged society

includes a comprehensive, holistic view covering diverse generations and their lifestyle, economic

status, cultural backgrounds and much more. As life expectancy increases, governments, health care

providers, service providers and the community need to adapt to enable members of the younger

generation to maintain their health and active participation in society, and to support the desire for

people to continue to live independently as they age. This International Workshop Agreement covers

key concepts that support certain on-going social changes. It aims to promote further deliberations

from service providers and standards bodies, among others, of these aspects that will not only address

existing issues, but also help to prevent potential future problems.

This International Workshop Agreement recognizes the wide range of global efforts to define social

infrastructure for aged societies and to offer consistent, personalized lifelong care. A common factor

in academic research and national/international guidelines is the promotion of the individual as an

equal partner in controlling his/her health care. This relates to all aspects of a person’s life, including

planning, decision making and day-to-day living, leading to a user-centred approach. The following five

key principles have been identified as the core elements for future investment:
a) human dignity;
b) productive ageing;
c) community-based services;
d) systemization with people at the centre;
e) pursuit of innovation for sustainability.
Guidance on these key principles is given in 3.1.

Consideration needs to be taken in delivering person-centred services. Care needs to be provided

ethically and respectfully, with the flexibility to meet the needs of diverse generations. Both the

individual and the wider society benefit because the individual experiences greater satisfaction with

his/her care and the social infrastructure that supports health care delivery is made more cost-

effective. The focus of this International Workshop Agreement is not to provide clinical guidance, but to

encourage health care service providers to drive for a shift in thinking. Harmonizing the concepts and

methodology internationally will streamline the market environment of providers and users of health

and care services, and build the basis for fair competition and development of related industries.

Establishing a common goal for standardization activities will help to provide life-long support for

aged societies in the most efficient and productive way, by addressing common challenges. There will

be closer examination on where standards can be used to bring about change. There is an increase in

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IWA 18:2016(E)

global awareness of the need for a sound social infrastructure to support ageing populations. There

are already some established platforms for knowledge sharing, but more needs to be done to align the

language used and to outline proven good practices that may influence new behaviour and practices.

This International Workshop Agreement aims to encourage:

— sharing of knowledge and best practices at global level, relating to a gradual increase over time of

aged societies;

— minimizing repetition and duplication of efforts, through the development of common approaches

to the challenges associated with societies that are not able to adapt to an increase in the older

population;

— improved realization and understanding of aged societies for policy makers, providers and the

general public;

— creation of innovative solutions, across multiple service sectors, that will allow people to remain

within their communities and outside of institutionalized care, where possible and for as long as

possible;

— economic benefits for governments and the general public, through the provision of better products,

services and systems.

Supporting material to accompany this International Workshop Agreement is available at the following

website: shop.bsigroup.com/iwa18.
vi © ISO 2016 – All rights reserved
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International Workshop Agreement IWA 18:2016(E)
Framework for integrated community-based life-long
health and care services in aged societies
1 Scope

This International Workshop Agreement provides a framework for addressing challenges faced by

societies that have been unable to adapt to an ageing population. It can also be used by stakeholders as

a useful reference at regional or global level.

This International Workshop Agreement addresses health, care and social challenges (including health

care needs, daily living tasks, well-being, combating isolation and keeping safe) to ensure that the

needs of individuals continue to be met as they grow older. It also outlines principles related to ethics,

community-based solutions, integration, person-centred solutions and innovation.
2 Terms and definitions
For the purposes of this document, the following terms and definitions apply.
2.1
community

group of people, often living in a defined geographical area, who exhibit some awareness of their

identity as a group, and who share common needs and a commitment to meeting them
[4]
[SOURCE: WHO Ageing and Health Technical Report, Vol.5 , modified]
2.2
community-based services
community-based care

blend of health and social services provided to an individual or family in his/her place of residence

for the purpose of promoting, maintaining or restoring health, minimizing the effects of illness and

disability on his/her normal lifestyle
Note 1 to entry: The term “community-based programmes” is also used.
[SOURCE: ISO/TR 14639-2:2014, 2.12, modified]
2.3
dignity
right of individuals to be treated with respect as persons in their own right
[4]
[SOURCE: WHO Ageing and Health Technical Report, Vol.5 ]
2.4
functional ability

health-related attributes that enable people to be and to do what they have reason to value

Note 1 to entry: It is made up of the intrinsic capacity of the individual, relevant environmental characteristics

and the interactions between the individual and these characteristics.
[5]
[SOURCE: WHO World Report on Ageing and Health ]
2.5
environments

combination of factors at all levels of services in the extrinsic world that form the context of an

individual’s life, including the built environment, people and their relationships, attitudes and values,

health and social policies, the systems that support them and the services that they implement

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IWA 18:2016(E)
[5]
[SOURCE: WHO World Report on Ageing and Health , modified]
2.6
health

state of complete physical, mental and social well-being and not merely the absence of disease or

infirmity

Note 1 to entry: Health has many dimensions (anatomical, physiological and mental) and is largely culturally

defined.
[4]
[SOURCE: WHO Ageing and Health Technical Report, Vol.5 ]
2.7
health promotion

combination of health education and related organizational, political and economic interventions

designed to facilitate behavioural and environmental adaptations that will improve or protect health

[4]
[SOURCE: WHO Ageing and Health Technical Report, Vol.5 ]
2.8
health system

people, institutions and resources, arranged together in accordance with established policies, to

improve the health of the population, while responding to people’s legitimate expectations and

protecting them against the cost of ill-health through a variety of activities, the primary intent of which

is to improve health

Note 1 to entry: Health systems fulfil three main functions: health care delivery, fair treatment of all and meeting

non-health expectations of the population. These functions are performed in the pursuit of three goals: health,

responsiveness and fair financing.

Note 2 to entry: A health system is usually organized at various levels, starting at the community level or the

primary level of health care and proceeding through the intermediate (district, regional or provincial) to the

government level.
[4]
[SOURCE: WHO Ageing and Health Technical Report, Vol.5 , modified]
2.9
healthy ageing

process of developing and maintaining the functional ability that enables well-being in older age

[5]
[SOURCE: WHO World Report on Ageing and Health ]
2.10
independence

ability to perform an activity with no or little help from others, including having control over any

assistance required rather than the physical capacity to do everything oneself
[4]
[SOURCE: WHO Ageing and Health Technical Report, Vol.5 ]
2.11
independent living

living at home without the need for continuous help and with a degree of self-determination or control

over one’s activities
[4]
[SOURCE: WHO Ageing and Health Technical Report, Vol.5 ]
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IWA 18:2016(E)
2.12
integrated care
integrated care services

methods and strategies for linking and coordinating the various aspects of care delivered by different

care systems, such as the work of general practitioners, primary and specialty care, preventive and

curative services, and acute and long-term care, as well as physical and mental health services and

social care, to meet the multiple needs of an individual client or category of persons with similar needs

Note 1 to entry: In this International Workshop Agreement, the scope of integrated care services includes

independence support care services as well as the interface with (but not the inclusion of) medical care. It also

includes independence support care services in the community after medical (curative) care has been delivered

by professionals.
[4]
[SOURCE: WHO Ageing and Health Technical Report, Vol.5 ]
2.13
integrated health services

continuum of services that are managed and delivered at different levels and sites within the health

system

Note 1 to entry: Care is provided according to the needs of the individual throughout the course of his/her life

Note 2 to entry: In this International Workshop Agreement, the scope of integrated health services includes

health promotion services as well as the interface with medical services, but does not include medical (preventive

and curative) services provided by professionals.
[4]
[SOURCE: WHO Ageing and Health Technical Report, Vol.5 , modified]
2.14
integration

coherent set of methods and models, on the funding, administrative, organizational, service delivery

and clinical levels, designed to create connectivity, alignment and collaboration within the health sector

[4]
[SOURCE: WHO Ageing and Health Technical Report, Vol.5 ]
2.15
intrinsic capacity
composite of all the physical and mental capacities of an individual
[5]
[SOURCE: WHO World Report on Ageing and Health , modified]
2.16
lifestyle

set of habits and customs, influenced, modified, encouraged or constrained by the lifelong process of

socialization, that carry health implications
[4]
[SOURCE: WHO Ageing and Health Technical Report, Vol.5 , modified]
2.17
long-term care

range of health care, personal care and social services provided to individuals who, due to frailty or

level of physical or intellectual disability, are no longer able to live independently

[4]
[SOURCE: WHO Ageing and Health Technical Report, Vol.5 , modified]
2.18
personal care

assistance with functions and activities normally associated with body hygiene, nutrition, elimination,

rest and walking, which enables an individual to live at home or in the community

[4]
[SOURCE: WHO Ageing and Health Technical Report, Vol.5 , modified]
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IWA 18:2016(E)
2.19
prevention

action aimed at promoting, preserving and restoring health when it is impaired and to minimize

suffering and distress
[4]
[SOURCE: WHO Ageing and Health Technical Report, Vol.5 , modified]
2.20
programme

organized collection of activities directed towards the attainment of defined objectives and targets

which are progressively more specific than the goals to which they contribute
[4]
[SOURCE: WHO Ageing and Health Technical Report, Vol.5 , modified]
2.21
provider
organization that provides a product or a service
EXAMPLE Producer, distributor, retailer or vendor of a product or a service.
Note 1 to entry: A provider can be internal or external to the organization.

Note 2 to entry: In a contractual situation, a provider is sometimes called “contractor”.

[SOURCE: ISO 9000:2015, 3.2.5]
2.22
quality of life

product of the balance between social, health, economic and environmental conditions which affect

human and social development

Note 1 to entry: It is a broad-ranging concept, incorporating a person’s physical health, psychological state, level

of independence, social relationships, personal beliefs and relationship to salient features in the environment.

[4]
[SOURCE: WHO Ageing and Health Technical Report, Vol.5 , modified]
2.23
system

network of interdependent components that work together to attain the goals of the complex whole

[4]
[SOURCE: WHO Ageing and Health Technical Report, Vol.5 ]
2.24
systemization

school of thought evolving from earlier systems analysis theory and advocating that virtually all

outcomes are the result of systems rather than individuals

Note 1 to entry: It is characterized by attempts to improve the quality and/or efficiency of a process through

improvements to the system.
Note 2 to entry: The term “systems approach” is also used.
[4]
[SOURCE: WHO Ageing and Health Technical Report, Vol.5 , modified]
2.25
well-being
dynamic state of physical, mental and social wellness

Note 1 to entry: It is a way of life which equips the individual to realize the full potential of his/her capabilities

and to overcome and compensate for weaknesses, and which recognizes the importance of nutrition, physical

fitness, stress reduction and self-responsibility
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IWA 18:2016(E)

Note 2 to entry: Well-being is viewed as the result of four key factors over which an individual has varying degrees

of control: human biology, social and physical environment, health care organization (system) and lifestyle.

[4]
[SOURCE: WHO Ageing and Health Technical Report, Vol.5 , modified]
3 Principles and social issues
3.1 Principles
3.1.1 General

Subclauses 3.1.2 to 3.1.6 provide guidance on five principles of solutions to health, care and social

challenges related to aged society.

In order to establish aged societies where people are able to stay healthy and active for as long as

possible and to continue to live in their communities with peace of mind and dignity, even when they

become frail, multiple stakeholders of our society (states, local governments, non-profit organizations,

enterprises and individuals) should adhere to the five principles described in 3.1.2 to 3.1.6.

3.1.2 Human dignity

Principle: Multiple stakeholders should hold firmly the principle of respect for human dignity

throughout a person’s life.

Dignity, the core value of human rights, is supported by an individual’s independence and positive

relationship with society. Although it is often overlooked due to the physical and mental changes that

accompany ageing, the respect for dignity should be upheld throughout people’s lives.

3.1.3 Productive ageing

Principle: Multiple stakeholders should adapt a productive ageing approach as the basis of their relevant

activities.

All individuals should be enabled to pursue a healthy life for as long as possible, as well as the

opportunities to work and to participate in social activities. At the same time, they should be able to

endeavour to maintain productive relationships with the people around them regardless of frailty,

while those people should also help to provide opportunities for them to continue to be productive.

3.1.4 Community-based services

Principle: Support and services such as health care, long-term care, preventive actions and support for

activities of daily life, all of which are necessary for people to be able to fully experience productive

ageing, should be rooted in communities to secure user accessibility and to enhance provider

responsibility and coherence.

Support and services of this kind are meaningless unless they are easily accessible in daily life. Providers

of the support and services should pursue active engagement with their stakeholders in communities.

3.1.5 Systemization with people at the centre

Principle: The support and services mentioned above should be person-centred and systemized so that

they can be provided efficiently in a seamless and flexible manner in the community, with users of such

services being at the centre of the system. Support and services should be flexible and adaptable to the

varying needs during a person’s life.

Support and services should not be provided in an uncoordinated and inflexible manner divided into

speciality silos.
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IWA 18:2016(E)
3.1.6 Pursuit of innovation for sustainability

Principle: Individual parts of systems and entire systems of support and services (mentioned

previously) should both be improved by the pursuit of innovation based on evidence, including those

from the salutogenic approach.

NOTE The salutogenic approach, introduced by Aaron Antonovsky, sees health as a movement in a continuum

between total ill health and total health. It puts more importance on people’s resources and capacity to create

health than the classic focus on risks, ill health and disease. It focuses on the ability or “sense of coherence”,

composed of the elements of comprehension, manageability and meaningfulness, enabling the use of resources

available to solve the problem. See Reference [6].

Health and care services and their systems should be continuously innovated to be more efficient

and of better quality at all times in a sustainable manner, supported by new technology and scientific

knowledge, as well as by social innovation, including behavioural changes not only of the aged but also

of the younger generation.
3.2 Social issues
3.2.1 General

Subclauses 3.2.2 and 3.2.3 outline some of the aspirations for aged societies in the future. They also

cover some of the challenges and barriers to meeting these aspirations that have been identified.

They are based on research undertaken with carers, nurses and members of the general public in the

UK during 2014, as part of a framework for standards to support innovation in long-term care (see

Reference [7]).
3.2.2 Future provisions for aged societies
3.2.2.1 Common principles

This subclause outlines some of the aspirations for aged societies in the future.

There are common values for provision of products and services to aged societies, which are focused on

providing health and social care needs in the home. Care and support should:
— be tailored to meet the realistic wishes of the recipient;
— be arranged in a timely manner;
— be provided in the home (where desired and if possible);
— provide flexibility over timings for receiving care services;

— be well coordinated by someone who knows the recipient and understands his/her needs;

— be delivered by a team that is trusted by the recipient.

Specific requirements for aged societies tend to increase as a person’s physical and/or mental health

declines. Keeping physically active and avoiding loneliness are fundamental aspects

...

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