1 2015/10/28

2Suggested ISO / IWA Contents (draft) – October 2015

3Community-based integrated life-long health and care services for aged
4societies
5
6
7

8Contents page

9Foreword...................................................................................................................................... 2

10Introduction................................................................................................................................... 7

111. Scope....................................................................................................................................... 9

122. Terms and definitions................................................................................................................ 9

133. Principles and social issues.................................................................................................... 15

14 3.1 Principles.......................................................................................................................... 15

15 3.2 Social issues..................................................................................................................... 16

16 3.3 Basic approach................................................................................................................. 22

174. Holistic framework of services................................................................................................38

18 4.1 Integrated health services (*See Appendix for services)...................................................39

19 4.2 Integrated care services.................................................................................................... 39

20 4.3 Social infrastructure.......................................................................................................... 40

215. Existing works and documents...............................................................................................40

226. Recommendations................................................................................................................. 41

23Annexes..................................................................................................................................... 42

24Bibliography................................................................................................................................ 47

25Appendix to holistic framework of services.................................................................................47

26
27

1
1
2
28Foreword

29ISO (the International Organization for Standardization) is a worldwide federation of

30national standards bodies (ISO member bodies). ISO's technical work is normally
31carried out through ISO technical committees in which each member body has the
32right to be represented. International organizations, governmental and non-
33governmental, in liaison with ISO, also take part in the work.
34
35In order to respond to urgent market requirements, ISO has introduced the
36possibility of preparing documents through a workshop mechanism, outside of ISO
37committee structures. These documents are published by ISO as International
38Workshop Agreements (IWA). Proposals to hold such workshops may come from any
39source and are subject to approval by the ISO Technical Management Board, which
40also designates an ISO member body to assist the proposer in the organization of
41the workshop. Although it is permissible that competing International Workshop
42Agreements exist on the same subject, an International Workshop Agreement are
43not to conflict with an existing ISO or IEC standard.
44
45An International Workshop Agreement is reviewed after three years, under the
46responsibility of the member body designated by the ISO Technical Management
47Board, in order to decide whether it will be confirmed for a further three years,
48transferred to an ISO technical body for revision, or withdrawn. If the International
49Workshop Agreement is confirmed, it is reviewed again after a further three years,
50at which time it will be either revised by the relevant ISO technical body or
51withdrawn.
52
53Attention is drawn to the possibility that some of the elements of this document
54may be the subject of patent rights. ISO should not be held responsible for
55identifying any or all such patent rights.
56
57

2
3
4
58IWA document active supporter and contributors
Name Representation
Aisha Naseer Fujitsu Laboratories of Europe Limited
Alex Ross Director, WHO Centre for Health Development (WHO Kobe Centre)
Alexander Peine Utrecht University
Alison Ingram Age UK
Amanda
Richardson BSI (British Standards Institution)
Andy Morley SW Digital Health Cluster & New Level Health Ltd
Anna Eldestrand Swedish Standards Institute
Anne
Livingstone Global Community Resourcing Pty Ltd Australia
Anthony
Ciccarello Philips
Azusa Yano Mitsui Sumitomo Insurance
Bert Mulder Haagse Hogeschool eSociety
Billi Ryska German Society for Orthopedics and Trauma
Blandine
Rougon-Sarlin A 26 Architecture
Christophe
Damian A 26 Architecture
Bo Hu Fujitsu Laboratories of Europe
Carla Gomes IPQ (Instituto Português da Qualidade)
Carolien Smits Windesheim, Kenniscentrum Gezondheid & Welzijn
Cees van der
Schans Hanze Hogeschool
Chantal Erault Ministry of Social Affairs, Health and Women’s Rights (France)
Dana Kissinger-
Matray ISO's Committee on Consumer Policy (COPOLCO)
Emelie Bratt IWA Secretary
Filiz Kocyigit ISO/TC 43 Acoustics; Atılım University
Fiona Taylor
(Housing) Longhurst Group
Fred te Riet Espria Icare en Kicun Advies (Domotica)
Hazel Harper Innovate UK, Independent Living Innovation Platform Programme Manager

3
5
6
Jeremy Thorp Health & Social Care Information Centre (HSCIC)
Hiroshi Genda Mitsui Sumitomo Insurance
Hiroshi Sasaki JP NC
Hiroshi Sato ISO/TC159 Ergonomics
Il Kon Kim HoD of Korean National Body for TC215 Health informatics
Jackie Marshall-
Balloch Innovate UK
Jacobijn
Gussekloo Leiden University Medical Centre
Jane Finnerty The Society of Later Life Advisers (SOLLA)
CEN/TC 431 Service Chain for Social Care Alarms; Swedish Consumers’
Jan-Erik Nyberg Association
Jean Michel
Hervouet Hager Electro SAS
Johann Wilhelm
Weidringer German Society for Orthopedics and Trauma
John Beard World Health Organization (WHO)
John Maingay British Medical Association
Joon Hyun Song South Korea
Jose ALCORTA ISO (International Organization for Standardization)
José Arredondo INN (Instituto Nacional De Normalizacion)
Julie Hunter PAS 278 independent living
Norwegian Social Research, Oslo and Akershus University College fort Applied
Kåre Hagen Sciences
Karen Batt Standards Australia
Kathryn
Bloomfield London Fire Brigade
Ken Tsugane Hitachi Ltd
Kyoko Okami Kao Corporation
Lisa Spellman ISO/TC215, Health informatics
Loic Garcon Innovation for Healthy Ageing, WHO Kobe Centre
Luttervelt wmo-raad Pijnacker-Nootdorp
Malcolm Fisk Coventry University
Marcel Gielen Mextal
Maria João Portuguese Institute for Quality (IPQ)

4
7
8
 Graca
Mariana
Soledad Funes IRAM (Instituto Argentino de Normalización y Certificación)
Marlou Bijlsma NEN (The Netherlands Standardization Institute)
Mary Lou
PELAPRAT ISO (International Organization for Standardization)
Maude Luherne AGE Platform Europe
Melvin Reynolds AMS Consulting
Michael
Glickman ISO/TC215, Health informatics
Michel Ballereau Le Noble Age - France
Minkman Vilans
Nancy Bestic CSA Group (Canadian Standards Association)
Nick Guldemond European EIP Active and Healthy aging; University Medical Centre Utrecht
Noriaki Sawa NHS GP attending as an independent
Okami Kyouko The Institute of Healthcare Innovation Project (HIP)
Olof Nordangård The Swedish Consumers’ Association
Paul Laffin British Medical Association
Per Kr Andersen Norwegian Directorate of Health/SAGS-ABHS ad hoc Healthcare services
Pierre Sebellin IEC SEG 3 Ambient Assisted Living (AAL)
Prof Takashi
Matsuura Kyoto University European Center
Rob Turpin BSI (British Standards Institution)
Sabrina Pit University Centre for Rural Health, University of Sydney, Lismore Australia
Sandra
Feliciano IPQ (Instituto Português da Qualidade)
Sartaj Singh SCC
Setsuko Saya OECD (Organisation for Economic Co-operation and Development)
Shahid Husain
Sheikh AGROSOL PAKISTAN
Shigeomi
Suzuki The Institute of Healthcare Innovation Project (HIP)
Shigeru Miyake Hitachi Ltd
Shuichi Tsuchiya The Institute of Healthcare Innovation Project (HIP)
Stefan Lundberg Vårdförbundet, Swedish Association of Health Professionals

5
9
10
 Stephen Kay ISO/TC 215/WG 1 Architecture, Frameworks and Models
Susan Harker ISO/TC 159 Ergonomics
Takeshi Koizumi Nichirei Corporation
Tetsu Tsuji The Institute of Healthcare Innovation Project (HIP)
Willeke van
Staalduinen Dutch Centre for Health Assets
Xavier Aumont ARCHEAN Technologies
Yoshiaki
Ichikawa IWA Chairman
Yusuke CHIBA ISO (International Organization for Standardization)
59
60

6
11
12
61Introduction
62This document defines the principles, social issues and approaches to fill gaps and shortcomings in the
63social infrastructure supported by the holistic framework of services that need to be brought to light on
64a global platform in order to share knowledge. Countermeasures to cope with insufficiencies in social
65infrastructures to adapt to a global ageing societies need to be addressed today. For the purposes of
66this proposal, a country with a population where more than 14% is 65 years or older is called an ‘Aged
67Society’. Where more than 21% of a population is 65 years or older, this is referred to as a ‘Super-aged
68society’.
69
70According to the UN periodical report by the year 2050, many countries are projected to become super-
71aged societies. In addition, developing countries and regions with rapid economic growth will be subject
72to changes to their ageing population over the next few decades. It is to be noted that within a well-
73supported infrastructure of an aged society it includes a comprehensive, holistic view covering diverse
74generations and their lifestyle, economic status, cultural background and much more. As life expectancy
75increases, governments, healthcare providers, service providers, and the community have to adapt to
76enable the younger generation to maintain their health and active participation in society, and to
77support the desire for people to continue to live independently as they age. This document key
78concepts that support the on-going social changes. It aims to promote further deliberations from
79service providers, standards bodies among others of these aspects which will not only address existing
80issues but also to help prevent potential future problems.
81
82This IWA recognises the wide range of global efforts to define social infrastructure for aged societies
83and to offer consistent, personalised lifelong care. The common factor from academic researches and
84national/international guidelines promote the insurance of a person is an equal partner in their health
85care. This relates to all aspects of a person’s life, including planning, decision making and day-to-day
86living leading to a user-centric approach. Five key principles have been identified as the core elements
87that need to be invested in. These key principles are further explained in section 3.1 Principles.
88 1. human dignity;
89 2. productive ageing;
90 3. community-based services;
91 4. systemization with people at the centre; and
92 5. pursuit of innovation for sustainability.
93
94Consideration needs to be taken in delivering person-centric services. Care is to be provided ethically

7
13
14
 95and respectfully with the flexibility to meet the needs of diverse generations. Both the individual and
96the health system benefit because the individual experiences greater satisfaction with their care, and
97the health system is more cost-effective. The focus of this document is not to provide clinical guidance
98but to encourage healthcare service providers to drive for a shift in thinking and also to offer
99government support in setting regulations in this area. Harmonizing the concepts and methodology
100internationally will streamline the market environment of providers and users of health and care
101services, and build the basis for fair competition and development of related industries.
102
103The common goal for standardization activities that is proposed in 6. Recommendations section will help
104to establish the life-long support for aged societies in the most efficient and productive way, by
105addressing common challenges. There will be closer examination on where standards can be used to
106bring about change. There is an increase in global awareness of the need for a sound social
107infrastructure to support aging populations. There are already some established platforms for
108knowledge sharing but more can be done to align the language used and proven good practices that
109may influence new behaviours and practices.
110
111The benefits of ISO standardization include:
112 - sharing of knowledge and best practices at a global level, relating to a gradual increase over
113 time of aged societies;
114 - minimizing repetition and duplication of efforts, through the development of common
115 approaches to the challenges associated with societies that are not able to adapt to an increase
116 in the older population;
117 - improved realization and understanding of aged societies for policy makers, providers and the
118 public;
119 - creation of innovative solutions, across multiple service sectors, that will allow people to remain
120 within their communities, and outside of institutionalized care where possible and for as long as
121 possible;
122 - economic benefits for governments and the public, through the provision of better products,
123 services and systems.
124

8
15
16
1251. Scope

126This International Workshop Agreement (IWA) gives guidelines to address the challenges related to
127societies that have been unable to adapt to the ageing population. It can also be used by stakeholders
128as a useful reference at a regional level.
130

131It addresses health, care and social challenges (including health care needs, daily living tasks,
132wellbeing, combating isolation, keeping safe and prevention) to ensure needs continue to be met as
133individuals age. It also gives principles related to ethics, migration, community-based solutions,
134integration and person-centred solutions.

1352. Terms and definitions

136The terms defined in this section relate specifically to this document as well as the future work carried
137out as a consequent of this document.
138

139Aged societies, super-aged societies

140A country with a population where more than 14% is 65 years or older is called an ‘Aged Society’.
141Where more than 21% of a population is 65 years or older, this is referred to as a ‘Super-aged society’.
142

143Ageing in place
144Meeting the desire and ability of people, through the provision of appropriate services and assistance, to
145remain living relatively independently in the community in his or her current home or an appropriate level
146of housing. Ageing in place is designed to prevent or delay more traumatic moves to a dependent
147facility, such as a nursing home.

148Source: WHO
149
150Community
151A group of people, often living in a defined geographical area, who may share a common culture, values
152and norms, and are arranged in a social structure according to relationships which the community has
153developed over a period of time. Members of a community gain their personal and social identity by
154sharing common beliefs, values and norms which have been developed by the community in the past
155and may be modified in the future. They exhibit some awareness of their identity as a group, and share
156common needs and a commitment to meeting them.

157Source: WHO
158

9
17
18
159Community-based care / services / programmes
160The blend of health and social services provided to an individual or family in his/her place of residence
161for the purpose of promoting, maintaining or restoring health or minimizing the effects of illness and
162disability. These services are usually designed to help older people remain independent and in their own
163homes. They can include senior centres, transportation, delivered meals or congregate meals sites,
164visiting nurses or home health aides, adult day care and homemaker services.

165Source: WHO, also ISO/TR 14639-2:2014(en), 2.12 Health Informatics

166

167Dignity
168The right of individuals to be treated with respect as persons in their own right.

169Source: WHO
170

171Health
172The state of complete physical, mental, and social well-being and not merely the absence of disease or
173infirmity. Health has many dimensions (anatomical, physiological and mental) and is largely culturally
174defined.

175Source: WHO
176

177Health promotion
178Any combination of health education and related organizational, political and economic interventions
179designed to facilitate behavioural and environmental adaptations that will improve or protect health.

180Source: WHO
181

182Health system
183The people, institutions and resources, arranged together in accordance with established policies, to
184improve the health of the population, while responding to people's legitimate expectations and
185protecting them against the cost of ill-health through a variety of activities, the primary intent of which is
186to improve health. Health systems fulfil three main functions: health care delivery, fair treatment of all,
187and meeting non-health expectations of the population. These functions are performed in the pursuit of
188three goals: health, responsiveness and fair financing. A health system is usually organized at various
189levels, starting at the community level or the primary level of health care and proceeding through the
190intermediate (district, regional or provincial) to the central level.

191Source: WHO
192

10
19
20
193Independence
194The ability to perform an activity with no or little help from others, including having control over any
195assistance required rather than the physical capacity to do everything oneself.

196Source: WHO
197

198Independent living
199Living at home without the need for continuous help and with a degree of self-determination or control
200over one's activities.

201Source: WHO
202
203

204Integrated care
205The methods and strategies for linking and coordinating the various aspects of care delivered by
206different care systems, such as the work of general practitioners, primary and specialty care, preventive
207and curative services, and acute and long-term care, as well as physical and mental health services and
208social care, to meet the multiple needs of an individual client or category of persons with similar needs.

209Source: WHO
210

211Integrated care / care services

212
213The methods and strategies for linking and coordinating the various aspects of care delivered by
214different care systems, such as the work of general practitioners, primary and specialty care,
215preventive and curative services, and acute and long-term care, as well as physical and mental
216health services and social care, to meet the multiple needs of an individual client or category of
217persons with similar needs.
218(Source: WHO Glossary)
219(note) In this IWA document, the scope of integrated care / care services includes the
220independence support care services as well as the interface with, but does not include, the medical
221care. It also includes the independence support care services in the community after medical
222(curative) care has been delivered by professionals.
223

224Integrated health services

225The management and delivery of health services so that clients receive a continuum of preventive and
226curative services, according to their needs over time and across different levels of the health system.
227(source : WHO Technical Brief No.1, 2008 "Integrated Health Services - What and Why?")

11
21
22
228(note) In this IWA document, the scope of integrated health services includes health promotion services
229as well as the interface with medical services, but does not include the medical (preventive and curative)
230services provided by professionals.
231
232Integration
233A coherent set of methods and models, on the funding, administrative,
234organizational, service delivery and clinical levels, designed to create connectivity,
235alignment and collaboration within the health sector.

236Source: WHO
237
238

239Lifestyle
240The set of habits and customs that is influenced, modified, encouraged or constrained by the lifelong
241process of socialization. These habits and customs include the use of substances, such as alcohol,
242tobacco, tea or coffee; dietary habits; and exercise. They have important implications for health and are
243often the subject of epidemiological investigation.

244Source: WHO
245

246Long-term care (LTC)A range of health care, personal care and social services provided to
247individuals who, due to frailty or level of physical or intellectual disability, are no longer able to live
248independently. Services may be for varying periods of time and may be provided in a person’s home, in
249the　community or in residential facilities (e.g. nursing homes or assisted living　facilities). These
250people have relatively stable medical conditions and are unlikely　to greatly improve their level of
251functioning through medical intervention.
252Source: WHO
253

254Personal care
255Functions and activities normally associated with body hygiene, nutrition, elimination, rest and walking,
256which enables an individual to live at home in the community.

257Source: WHO
258

259Prevention
260This is aimed at promoting health, preserving health and restoring health when it is impaired and to
261minimize suffering and distress.
262There are various levels of prevention:

12
23
24
263- Primordial prevention: Actions and measures that inhibit the emergence and establishment of
264 environmental, economic, social and behavioural conditions, cultural patterns of living, etc., known
265 to increase the risk of disease.
266- Primary prevention: The protection of health by personal and community-wide actions of measures
267 provided to individuals to prevent the onset of a targeted condition.
268- Secondary prevention: Measures that identify and treat asymptomatic persons who have already
269 developed risk factors or preclinical disease, but in whom the condition is not clinically apparent.
270 These activities are focused on early case finding of asymptomatic disease that occurs commonly
271 and, without treatment, has a significant risk of negative outcomes.
272- Tertiary prevention: A process aimed at limiting the negative effects of an established disease.

273Source: WHO
274
275Programme
276An organized collection of activities directed towards the attainment of defined objectives and targets
277which are progressively more specific than the goals to which they contribute.

278See ‘health programme’; ‘care programme’.

279Source: WHO
280

281Provider
282An individual health care professional, a group or an institution that delivers care services.

283Source: WHO
284

285Quality of Life (QoL)

286The product of the balance between social, health, economic and environmental conditions which affect
287human and social development. It is a broad-ranging concept, incorporating a person’s physical health,
288psychological state, level of independence, social relationships, personal beliefs and relationship to
289salient features in the environment. As people age, their quality of life is largely determined by their
290ability to access needed resources and maintain autonomy and independence.

291Source: WHO
292

293Safety
294A judgment of the acceptability of risk (a measure of the probability of an adverse outcome and its
295severity) associated with a given situation or setting.

296Source: WHO

13
25
26
297
298Salutogenesis / salutogenic
299A theory that puts more importance on people’s resources and capacity to create health than the
300classic focus on risks, ill health and disease, with the ability called sense of coherence (SOC),
301composed of the elements of comprehension, manageability and meaningfulness, enabling the use
302of resources available to solve the problem.
303(source: Journal of Epidemiology and Community Health http://jech.bmj.com/content/59/6/440.full)
304(note) The theory was introduced by Aaron Antonovsky. It sees health as a movement in a
305continuum between total ill health and total health.
306

307Specialist
308A health professional who is specially trained in a certain branch of his/her profession related to specific
309services or procedures.

310Source: WHO
311

312Standard
313A quality measure or reference point established as a rule or model by authorities, custom or general
314consent, against which things can be evaluated or should conform.

315Source: WHO
316

317System
318A network of interdependent components that work together to attain the goals of the complex whole.

319Source: WHO
320

321Systemization
322ALTERNATIVE: Systems Approach
323A school of thought evolving from earlier systems analysis theory and advocating that virtually all
324outcomes are the result of systems rather than individuals. In practice, systemization is characterized by
325attempts to improve the quality and/or efficiency of a process through improvements to the system.

326Source: WHO
327

328Well-being
329A dynamic state of physical, mental and social wellness; a way of life which equips the individual to
330realize the full potential of his/her capabilities and to overcome and compensate for weaknesses; a

14
27
28
331lifestyle which recognizes the importance of nutrition, physical fitness, stress reduction, and self-
332responsibility. Well-being has been viewed as the result of four key factors over which an individual has
333varying degrees of control: human biology, social and physical environment, health care organization
334(system), and lifestyle.

335Source: WHO

3363. Principles and social issues

337
3383.1 Principles

3393.1.1 General
341This clause provides guidance on five principles of solutions to health, care and social challenges
342related to aged society.
343In order to achieve aged societies where people are able to stay healthy and active for as long as
344possible and can continue to live in their communities with peace of mind and dignity, even when they
345become frail, multiple stakeholders of our society such as states, local governments, non-profit
346organizations, enterprises, and individuals, should adhere to the following five principles.

3473.1.2 Dignity
348The principle is; multiple stakeholders should hold firmly the viewpoint of “respect for human dignity
349throughout lifecycle”.
350
351Dignity, the core value of human rights, is supported by individuals’ independence and positive
352relationship with society. Although it is often overlooked due to the physical and mental changes that
353accompany ageing, the respect for dignity should be upheld throughout people’s lives.

3543.1.3 Productive ageing

355The principle is; multiple stakeholders should adapt a “productive ageing approach” as the basis of their
356relevant activities.
357
358All individuals should be enabled to pursue a healthy life for as long as possible, as well as the
359opportunities to work and to participate in social activities. At the same time, they should be able to
360endeavour to maintain the productive relationship with the people around them regardless of frailty,
361while all the people around should also help and provide the opportunities for them to continue to be
362productive.

15
29
30
3633.1.4 Community-based services
364The principle is; support and services such as health care, long-term care, preventive actions, and
365support for activities of daily life, all of which are necessary for people to be able to fully experience
366productive ageing, must be rooted in communities to secure user accessibility and to enhance provider
367responsibility and coherence.
368
369These support and services are meaningless unless they are easily accessible as necessary in daily
370life. Providers of these support and services should pursue active engagement with their stakeholders in
371communities.

3723.1.5 Systemization with people at the centre

373The principle is; support and services mentioned above should be person-centred and systemized so
374that they can be provided efficiently in a seamless and flexible manner in the community with users of
375such services being at the centre of the system. Support and services should be flexible and adaptable
376to the required needs varying during a person’s lifecycle.
377
378These support and services should not be provided in an uncoordinated and inflexible manner divided in
379specialty silos.

3803.1.6 Pursuit of innovation for sustainability

381The principle is; both individual parts of systems and entire systems of support and services (mentioned
382previously) should be continuously improved by pursuit of innovation based on evidence, including
383those from the salutogenic approach, aiming to achieve sustainable harmonization of approaches from
384individual users and society.
385
386Health and care services and their systems should be continuously innovated to be more efficient and of
387better quality at all times in a sustainable manner, supported by new technology and scientific
388knowledge as well as the social innovation including the behavioural changes of not only the aged but
389also the younger generation.
390

3913.2 Social issues

3923.2.1 General
393This section outlines some of the aspirations for aged societies in the future. It also covers some of the
394challenges and barriers to meeting these aspirations that have been identified. It is based upon some
395research that was undertaken with carers, nurses and members of the public in the UK during 2014, as

16
31
32
396part of a framework for standards to support innovation in long term care (“A framework for standards to
397support innovation in long term care, BSI, September2014”)..
398

3993.2.2 Future provisions for aged societies

4003.2.2.1 Common principles

401This section outlines some of the aspirations for aged societies in the future.
402
403There are common principles for provision of products and services to of aged societies, which are
404focused on providing health and social care needs in the home. Care and support should be:
405 - tailored to meet the realistic wishes of the recipient;
406 - be arranged in a timely manner;
407 - provided in the home (where desired and if possible);
408 - provide flexibility over timings for receiving care services;
409 - be well co-ordinated by someone;
410 - who knows the recipient and understands their needs;
411 - and delivered by a team who the recipient trusts.
412
413Specific requirements for aged societies tend to increase as a person’s physical and/or mental health
414declines. Keeping physically active and avoiding loneliness are fundamental aspects to ensuring
415wellbeing. Communities are an invaluable source of support as the health and care needs of an
416individual change. The public need to be able to access medical and lifestyle services easily, to ensure
417a continued positive outlook on life. As personal care requirements increase, the focus often moves
418towards accomplishing routine day-to-day living tasks in the home. With cognitive impairments, planning
419financial and personal security becomes a greater priority, along with the ever-changing contexts and
420technologies surrounding financial transactions, and economic changes.
421
422Changes in physical and/or mental capabilities are often predicted by key milestones that result in
423greater challenges, such as restrictions on mobility, memory loss, or death of a partner. An increase in
424single people (as opposed to couples), or single parent families may encourage greater independence
425for individuals in the future and that the public is now becoming more aware of availability and choice of
426long term care services in the home.

4273.2.2.2 Medical needs

428Medical needs include the provision and review of medical prescriptions, and the diagnosis and
429management of acute conditions. Nursing and social care requirements may include administering

17
33
34
430medication at the right time and ensuring appropriate equipment and adaptations are in place.
431
432The public should have opportunities to receive health and social care in settings beyond traditional
433surgeries, clinics and hospitals. These could include:
434 - ‘24/7 one-stop’ healthcare centres with no waiting times, offering a full range of services;
435 - drop-in centres for health and other community services in shops and pharmacies;
436 - clinics in the high street or community centres;
437 - physiotherapists in leisure centres;
438 - and where possible, services (such as podiatry, ophthalmology dentistry and physiotherapy) in
439 the home.
440
441Aged societies should include support that is well co-ordinated across medically qualified professionals.
442Improvements to ‘out of hours’ services will be required, and a greater willingness of services to visit the
443home, or other locations.
444
445Systems for making medical appointments will need to become simpler and remote consultations (e.g.
446via Skype) will need to become routine. Healthcare professionals should be able to spend more time
447with individuals to assess and review their needs, wishes and aspirations. Consumers of healthcare
448services should be able to undertake regular reviews involving themselves, their family, medical and
449care professionals to discuss their overall wellbeing and satisfaction.

4503.2.2.3 Personal care

451Personal care is related to the ability of a person to dress, bathe, go to bed and get up, either
452individually or with a third party, and the associated moving and lifting of people. It can apply in the
453home, in an institution or another location (e.g. on a holiday). Personal care needs to fit in with the
454cultural normality and attitudes provided by the family or community. An individual should always have a
455choice of carer and should expect consistency and competence.
456
457In the future, there should be greater time provided for carers to spend with individuals, to manage their
458needs as defined by them, rather than being bound by the constraints of workload. There should be
459flexibility around the times of day for when tasks are carried out (e.g. bathing and eating at appropriate
460times). Housing should be developed and adapted so that it is easier to provide long term care. Digital
461technologies can play a part in providing services or requesting assistance.
462
463The public should be involved in early discussions about preferences for end-of-life care, including the
464option of living wills and spiritual support. Professional support should be provided by a consistent team

18
35
36
465that can all work together. Greater support and counselling should be provided to spouses and offspring
466for a sustained period after a loved one has passed away.

4673.2.2.4 Daily living tasks

468Day-to-day living tasks include activities such as cooking, shopping, housework, laundry, gardening and
469transport. It requires the provision of suitable individuals and services to allow this to happen effectively.
470
471Individuals and carers should not be time-pressured when undertaking these tasks. Where possible, the
472wider community could become involved in providing suitable services, and consideration should be
473given to the use of ‘time bank’ models for providing care.
474
475Private businesses should recognize the opportunity for individuals to outsource some of their daily
476living tasks (e.g. laundry services could be undertaken by supermarkets). Some tasks could be
477completed by electronic means, but the solutions would need to be cost-effective. Service providers
478should become more aware of the needs of aged societies and offer services that are specifically
479designed for older people. Communities should offer better transport options, including dedicated car
480parking spaces.
481
482There are some daily tasks that are considered important by people, such as gardening, but are often
483seen as being less important in terms of overall care packages. These tasks should become routinely
484available to those who want them.

4853.2.2.5 Maintaining relationships and community involvement

486It is important to ensure an individual’s inclusion in appropriate exercise, leisure and spiritual activities,
487that allow them to enjoy their life, as well as allowing them to give something back to the community if
488desired. Activities can involve befriending services, and a role for people to support others across their
489community. Aged societies and their families see the value in paying for activities so that they enjoy life,
490but cost can sometimes be a barrier.
491
492Aged societies consist of intelligent, experienced adults with a right to make their own choices for
493socializing and for leisure activities (rather than having certain activities forced upon them). In the future,
494broader activities should become available so that there is something for everybody to enjoy. Leisure
495centres should run classes and programmes for different levels of fitness. For those unable or unwilling
496to participate, technology currently used by the digital gaming industry could provide a suitable
497alternative. Access to pets is also regarded as an important aspect of companionship.
498

19
37
38
499It is important to provide companionship, and help people with all of their communication needs, from
500physical meetings to remote contact, both inside and outside of the home. Family and friends are often
501the main source for this support, however, there is a wider role for the community. Businesses and
502professionals may need to encourage socializing aspects (e.g. by provision of suitable transport).
503Technology is seen by many people as an enabler to bring people together who want to be connected
504(e.g. video calls).

5053.2.2.6 Keeping safe

506Ensuring people are safe inside and outside of the home is widely recognized as an important aspect of
507assuring an aged society against unusual, criminal or adverse events. This can include protection from
508robbery, fire and extreme weather conditions.
509
510In the home, social alarms and CCTV are well known and effective devices for monitoring and alerting
511for assistance, should an incident occur. However, these come at a cost, do not routinely work outside
512the home and can be set off in error. Some neighbourhoods provide schemes to prevent unwanted
513visitors to the doorstep, and to keep a watch on each other.
514
515Outside the home, certain technologies have been applied to assist those with cognitive impairments,
516but these are not in mainstream use. Commercial organizations are training their staff to become more
517aware of societal issues, which demonstrates the start of a move towards tailoring services towards the
518needs of society.
519
520In the future, digital technology could provide a way of integrating information from around the home,
521along with personal data (e.g. location) to ensure that a person is safe and secure.

5223.2.3 Challenges and barriers to creating new approaches

5233.2.3.1 Person-centred care provision

524Challenges relating to the provision of services that are joined up, and centred on the user include:
525 - achieving an early diagnosis (particularly where this can qualify a person for extra support);
526 - providing immediate access to new products and services, when a sudden deterioration in
527 health is experienced;
528 - communication and sharing of information between different professionals and agencies.
529
530One of the barriers to achieving this includes the fragmentation of different agencies, and a protective
531attitude towards data sharing and communication. The loss of continuity between patients and trusted
532professionals, when they move to other jobs also hindered good person-centric provision.

20
39
40
5333.2.3.2 Education and training
534One of the main challenges in providing high quality products and service to aged societies is having
535access to competent and motivated carers and support staff. The economics behind many services
536result in staff being employed on low wage contracts, and services not being available at the times they
537are needed. In many cases, training is carried out on the job, rather than as part of a formal programme.

5383.2.3.3 Maintaining relationships and community involvement

539The barriers to maintaining social relationships and involvement in the community can include:
540 - a lack of variety of suitable activities to suit all cultures, interest, levels of education and abilities;
541 - poor transport options and a lack of different environments that can be accessed;
542 - a lack of concessionary rates;
543 - clarity in identifying suitable activities, particularly those with cognitive impairments.

5443.2.3.4 Developing the home environment

545It is often difficult to adapt existing housing quickly, when changes are needed due to the costs. New
546build housing does not necessarily take into account the needs of older people, such as space to move
547around beds, and suitable bathrooms. Some products could be better designed, in order to ensure that
548they will be used by consumers. In some regions, retirement villages have been built, but these are not
549always available.

5503.2.3.5 Interface with technology

551Whilst technology is seen as a benefit in many cases, it is not universally welcomed by everyone. A lack
552of user-friendliness, accessibility and reliability are the main challenges. It is important that technology is
553seen as being complimentary to interaction, and not replacing it.

5543.2.3.6 Economic aspects

555The public should be encouraged to plan ahead for their future needs, rather than waiting for a
556deterioration in their health and either being unwilling to seek assistance, or assuming that help would
557be provided automatically. This will help to reduce difficulties when there is a sudden change, and allow
558for better outcomes. However, some people think there is often a lack of reward for those who have
559carefully planned their future, in comparison with those that haven’t and this can cause resentment.

560Systems and services need to be developed that are seen as fair and affordable, and make sense to the
561people who use them. Where funding is provided, it should allow users to freely select products and
562services that meet their needs rather than only allow access to a pre-established specification. Self-
563management of funding should be made as simple as possible for users in order to allow them to
564personalize their choices for care and services.

21
41
42
5663.2.3.7 Societal attitudes
567One of the key challenges to creating an effective aged society relates to building more caring and
568respectful attitudes within individuals and businesses. Families are not always available to provide
569support, and other people could provide more practical support, such as visiting neighbours,
570undertaking work experience, or providing help with physical demanding tasks.
571
572Whilst individual professional carers are valued, there is a perception that some organizations only have
573an interest in making money. The perception of these organizations needs to be enhanced, in order to
574attract more high calibre and motivated people to work for them.

575

5763.3 Basic approach

5773.3.1 Health and care in relation to ageing

578The relationship of health and care with ageing is shown in the following Figure.
579
580

581 Figure 1 – Health maintenance and care through the life cycle

582
583
584The vertical scale of Figure 2 shows the degree of independence.
IADL (Instrumental This includes, for example, the use of transportation, answering the
Activities of Daily telephone, shopping (plus cooking, housekeeping, cleaning,
Living) medication management, monetary management), etc.

22
43
44
 ADL (Activities of Daily This includes the most basic human activities like walking and moving
Living) around, going up a few steps of stairs, bathing (plus eating, clothing,
continence, grooming), etc.
IADL Disability This indicates the level that ADL is independent but IADL needs
assistance.
ADL Disability This indicates the level that both ADL and IADL need assistance.

585Independence levels can deteriorate due to various diseases such as cerebral vascular illnesses as well
586as the progress of age-related frailty. These diagrams are the outcome of tracing 6,000 elderly people in
587Japan over a twenty-year period. 20% of males either die of diseases or go into severe levels of long-
588term care before reaching 70 years of age. Those who survive this stage follow slightly different frailty
589progress patterns depending on whether they are male or female.
590
591The survey also showed that for females, younger generations had a higher degree of connectivity,
592while on the other hand, for males, the younger generations had less mutual connectivity than older
593generations. Increasing loneliness for men is a big concern. With males and females totalled, 80% of
594people start losing independence steadily from their mid-70s. There are three major imminent actions
595that need to be encouraged1.

596The first action is to shift the starting age of deterioration forward even 2 or 3 years. Extension of healthy
597age and the independence period, enabled by physical and cognitive functions, benefits not only older
598people but community and society as a whole.
600
601The second action is to create the right infrastructure for the ‘ageing of the aged population’. As the
602increase of frail older people is inevitable, social infrastructure to embrace and support them should be
603designed and constructed. This includes hard infrastructure, such as housing and transportation as well
604as soft infrastructure such as medical care, long-term care, pension systems, etc.
605
606The third action is to implement the measures to increase the connectivity within, and coherence of, the
607community where the post-retirement generation spend the rest of their later life.

6083.3.2 Stages of health promotion and care provision

609Promotion of health, prevention of diseases and frailty, and the degrees of providing care can be
610approached in four stages. Each stage has objectives that need to be achieved, with certain expected
611effects, and should have the relevant international standards in line with the established objectives. The

451 ‘Platinum Vision Handbook’, Hiroko Akiyama

23
46
47
612four stages of approach are:
613 1. Prevention of Lifestyle Diseases,
614 2. Prevention of Frailty,
615 3. Care for Assisting Independence, and
616 4. Care for Living in the Community.
617
618The objective of preventing lifestyle diseases and frailty is to prolong healthy life expectancy. It aims to
619enable people of all ages to live independently from care or hospitals. Its expected effects are the
620overall improvement of social efficiency, including the reduction of costs of medical and long-term care
621both for the individual and for the society.
622
623The objective of providing care for assisting independence is to improve the ADL, and its expected
624effect is the minimization of long-term care costs. Finally, the objective of providing care for living in the
625community is to improve the quality of life (QOL) of the people who reach this stage. Its expected effect
626is the improvement of long-term care cost efficiency.
627
628The following matrices show details of the above-mentioned concepts.

629Table 1 – The objectives and effects for the 4 stages of approach

Four Stages of Approach
Health Promotion and
Prevention of Lifestyle
Diseases
Prevention of Frailty
(incl. dementia)
Independence Support Care
(incl. dementia)
Long-term Care in the
Community
(incl. dementia)
(1) Influencing factors:
Objectives
Prolongation of Healthy Life
Expectancy (1)
Prolongation of Healthy Life
Expectancy (1)
Improvement of Functional
Capabilities and Abilities
Improvement of QOL (2)
Effects
Improvement of Social
Efficiency and Reduction of
Medical Costs
Improvement of Social
Efficiency and Reduction of
Medical and Long-Term Care
Costs
Improvement of Long-Term
Care Cost Efficiency
Improvement of Long-term
Care Cost Efficiency

a. Nutrition / Malnutrition

b. Injury prevention

c. Physical activity

24
48
49
 d. Mental activity (life-long learning)

e. Social connectedness (inclusion/participation)

(2) According to WHO definition (WHOQOL)

630Each of the four stages of approach can contain three levels of international standards (see Table 2).
631First, the social system level, second, the business system level, and third, services and products level.
632The services and products are provided by the business system, and the business system is supported
633by, and is within the framework of, the social system.
634
635Table 2 – The three levels of implementation in relation to the 4 stages of approach (see Cube
636and Matrix in Figure 5)
The Related Social Level Projects Level Services and Products Level
Levels >
Health Community-based Health Check by (See Cube and Matrix for 3
Promotion and Health Support Criteria levels x 4 stages)
Prevention of Plan Health Promotion
Lifestyle (see Box 1) Program
Diseases Assessment by
Health Data

Prevention of Community-based Health Check (See Cube and Matrix for 3

Frailty Health Support (Frailty) by Criteria levels x 4 stages)
(incl. dementia) Plan Health Promotion
(see Box 1) Program
Assessment by
Frailty Data
Independence Community-based Evaluation of (See Cube and Matrix for 3
Support Care Care Support Plan Long-term Care levels x 4 stages)
(incl. dementia) (see Box 1) Level by Criteria
(see Box 2)
Independence
Support Program
Assessment by
ADL Data
Long-term Community-based Evaluation of (See Cube and Matrix for 3
Care in the Care Support Plan Long-term Care levels x 4 stages)

25
50
51
 Community (see Box 1) Level by Criteria
(incl. dementia) (see Box 2)
Long-term Care
Program
Assessment by
Care Data
637

638On the Social Level (Table 2) two categories of social plans are to be developed. The first category
639consists of two stages of Community-based Health Support Plans. The second category consists of two
640stages of Community-based Care Support Plans (see Box 1). The Social Level is lead mainly by
641municipal governments to provide health and care services needed in the communities.
642
643On the Projects Level (Table 2) three categories of standards are to be developed. First is the
644standardization of specific activities such as criteria establishment (health screening criteria, frailty
645screening criteria, and evaluation criteria of long-term care) (see Box 2). The second is program
646development (health promotion program, independence support program, and long-term care program).
647The third is the assessment of the outcome by data utilization (health data, frailty data, ADL data, care
648data, etc.). These standardization efforts are repeated in cycles of ‘criteria establishment > programs
649development > assessment > criteria review’. The projects Level is carried out mainly by the multiple
650services providers based on the needs of the people in the communities.
651
652On the Services and Products Level (Table 2) the standardization of a variety of services and products
653is developed in accordance with the objectives and effects in Table 1. The Services and Products Level
654is achieved by the specific services delivered to the people who are in need of them.

656All three levels and four stages are illustrated in the Cube and Matrix in Figure 5.
657

26
52
53
658

659

660

661

662

663

<Box 1> Community-based health support plan, an example

664In Japan a variety of community-based project plans are built into local municipalities’
activities under the mandate of the Japanese Government, including a health promotion
665plan, a data health plan, a long-term care insurance plan, and an aged person’s welfare
plan. Japan’s community-based integrated care system has been developed in order to
‘bundle’ these plans. Five components of Japan’s community-based integrated care
666system are: healthcare, long-term care, prevention, housing and livelihood support
667services.

<Box 2> Evaluation of long-term care

In order to provide care to the elderly in need of Long-term care (LTC) efficiently and
effectively, it is necessary to establish a predetermined criteria based on which the degree
of needed LTC is specifically measured, and also the amount and categories of
appropriate LTC to be provided are judged.
In Japan, for example, each aged person in need of LTC is evaluated and given the
Certification of Needed LTC based on a 5-grade system authorized by the government,
each grade indicating the total amount of LTC within which necessary care services are
appropriately mixed and provided. This kind of system enables the measurement of the
effect of provided care upon the improvement of LTC need. It further makes it possible to
measure and quantify how much physical labour has been successfully substituted by the
ICT and/or robots developed and used for providing such care.
An example is shown below of the Criteria for Long-term care Levels as established in
Japan (Ministry of Health, Labour and Welfare) – based on ‘One-minute Time Study’
method resulting from 48-hour observations of 3,500 patients in the care-providing
institutions.

Support 1 Standard time required for long-term care is assessed at 25

Required minutes or more but less than 32 min, or its equivalent.
“ 2 “ 32 – 50 min.
Care Level 1 “ “
“ 2 “ 50 – 70 min.
“ 3 “ 70 – 90 min.
“ 4 “ 90 – 110 min.
“ 5 “ 110 min or more.

27
54
55
6683.3.3 Healthy Ageing

669

670
671
672
673Figure 3 Health systems and social care
674(World Report on Ageing and Health, WHO, 2015)
675
676Healthy ageing, according to WHO, is ‘the process of developing and maintaining the functional ability
677that enables well-being in older age’. The functional ability comprises the health-related attributes that
678enable the people to be and to do what they have reason to value. It is made up of intrinsic capacity of
679the individual, relevant environmental characteristics and the interactions between the individual and
680these characteristics. Intrinsic capacity is the composite of all the physical and mental capacities of an
681individual. Environments include, from the micro- to macro-level, components such as home,
682communities, society, health and social policies, societal attitudes and values, systems that support the
683people, and the services provided to them.
684
685

686
687
688
689

28
56
57
 High and stable Declining Significant loss of
capacity capacity capacity

690 Function
al
691 ability
692
693 Intrinsi
c
694 capacit
695 y

696 Health services:

Prevent chronic
697 conditions or ensure Reverse or Manage
698 early detection slow advanced
and control declines in chronic
699 capacity conditions
Support capacity-
700 Long-term care: enhancing behaviours
Ensure a
701 dignified late
life
702
703 Promote capacity-enhancing
Remove barriers to participation,
behaviours compensate for loss of capacity
704 Environments:
705

706 Figure 4 A public-health framework for Healthy Ageing: opportunities for public-health action
707 across the life course
708(World Report on Ageing and Health, WHO, 2015)

709
710Building and maintaining the intrinsic capacity, and fostering the functional ability,
711to realize the optimal trajectory of individuals, we can consider the approaches from three common
712periods - high and stable capacity, declining capacity and significant loss of capacity. In each period of
713this continuum, supportive measures to help achieve this objective can be provided in three aspects as
714shown in the diagram - health services, long-term care and environments.
715

7163.3.4 Reference architecture

7173.3.4.1 The structure of holistic framework of services

718
719

720 Figure 5 – A possible structure of IWA and the services

721

29
58
59
722

723
724Integrated health services provide health check and guidance, and health promotion services including
725social participation. Integrated care services provide independence/autonomy support and social care
726services in coordination with medical care services. To support these services, a social infrastructure
727system would provide the housing, community, economy, technology and innovation.
728

7293.3.4.2 The cube and matrix

730The Cube below shows the relationship between the three-level approach to four stages of ageing and
731the Holistic Framework of Services.
732

30
60
61
733

734 Figure 6 – The Cube

735The five principles, explained earlier, are the overarching background for all dimensions of approach,
736stages and services depicted on the Cube. The three-level approach and four stages of ageing depicted
737on the top face and the side face of the Cube respectively, as well as the relationship between these two
738dimensions are shown earlier in Tables 1 and 2. The ‘criteria > program > assessment’ cycle is
739particularly important Projects Level, as referred to in Table 2.
740
741The Holistic Framework of Services is shown in the previous section. Its main service categories are
742health services, care services and social infrastructure. A further breakdown of services is shown in
743Section 4. It should be noted that this framework itemizes services extensively but is not exclusive. This
744framework is able to develop continuously into the future.

746The Cube (3 levels x 4 stages x 3 genres) is a cabinet to organize the services (currently 43+) listed in
747section 4. The services are a continuum that needs to be linked and integrated seamlessly to optimize
748efficiency and effectiveness, person-centred, with the 5 principles in place. The principles are also the
749prerequisites that need to pervade all the check cycles of criteria – program – assessment.
750WHO’s newest definition of ‘Healthy Ageing’ should be the overarching guiding principle as well.
751
752The following Matrix indicates the inter-relationship of specific services of the Holistic
753Framework of Services with the three levels of approach and four stages of ageing.
754

31
62
63
755
756

32
64
65
757

758

33
66
67
759

34
68
69
760

35
70
71
761

36
72
73
762

37
74
75
763

764

7654. Holistic framework of services

766In the delivery of holistic health and care services to any society, consideration has to be given to the
767needs of individuals as well as how the range of services are connected to each other. This framework
768includes varietal services relevant to health and care in aged societies. It illustrates the diversity of
769service sectors involved, many of which will be catering to a wide range of age groups. The list is not

38
76
77
770complete nor exclusive. See Appendix for Individual Services.

771Integrated health services (*See Appendix for services)

772Health Check and Guidance Services
773Health Check and Guidance Services on Non-professional Level
774Health Check and Guidance Services by Professionals
775‘Data Health’ Project
776Health Guidance Services based on Health Information
777Healthcare Data Trust Services
778Health Check Devices
779Health Promotion Services
780Walking Support Services
781Sleep Care Services
782Exercise/Fitness Services
783Diet and Dietary Support Services
784Oral Care Services
785Beauty Services
786Tourism Services
787Social Participation
788Job Matching, Volunteer/Part-time Work
789Hobbies, Community Activities

790Integrated care services

791Independence Support Services
792Welfare Equipment Providing Services
793Care/Communication Robots
794Home ICT
795Continence Care Services
796Toileting and Bathing Services
797Care Foods and Delivery Services
798Living Support Services (watching, counselling, housekeeping, etc.)
799Independence/Rehabilitation Assistance Care Services
800Guardian of Adults
801Long-term Care Services
802House Visitation Services
803Day Services

39
78
79
804Short Stay Services
805Small-scale, Multi-functional at Home Care Services
806Periodic/on-going visits by a long-term care provider or nurse

807Social infrastructure
808Risk Management*
809Insurance Services (life insurance, LTC insurance)
810Financial Services
811Housing
812City Planning and Management
813Community Coordination
814ICT Services
815Transportation Support Services
816Home Delivery Services
817Home Security Services
818Protection from Fraud
819Fostering of Experts and Procuring of Labour
820Social Interaction Services
821Community Information Services
822…..
823

8245. Existing works and documents

825ISO Committee titles
826ISO/TC 71/SC 7 Maintenance and repair of concrete structures
827ISO/TC 121/SC 3 Lung ventilators and related equipment
828ISO/TC 43 Acoustics
829ISO/IEC JTC 1 ISO/IEC Joint Technical Commitee for Information Technology
830ISO/IEC JTC 1/SC 28 Office equipment
831ISO/IEC JTC 1/SC 35 User interfaces*ISO/CEI JTC 1/SC 35 Interfaces utilisateur
832ISO/TC 159 Ergonomics
833ISO/TC 159/SC 5 Ergonomics of the physical environment
834ISO/TC 159/SC 3 Anthropometry and biomechanics
835ISO/TC 94 Personal safety - Protective clothing and equipment
836ISO/TC 22 Road vehicles
837ISO/TC 59/SC 16 Accessibility and usability of the built environment

40
80
81
838ISO/TC 43/SC 1 Noise
839ISO/TC 225 Market, opinion and social research
840ISO/TC 213 Dimensional and geometrical product specifications and verification
841ISO/TC 233 Societal security
842ISO/TC 37 Terminology and other language and content resources
843ISO/TC 147/SC 5 Biological methods
844ISO/IEC JTC 1/SC 6 Telecommunications and information exchange between systems
845ISO/TC 268/SC 1 Smart community infrastructures
846ISO/TC 268 Sustainable development in communities
847ISO/TC 215 Health informatics
848ISO/TS 13131:2014 Health informatics -- Telehealth services -- Quality planning guidelines
849ISO/TC 173/SC 1 Wheelchairs
850ISO/TC 249 Traditional Chinese medicine
851ISO/TC 210 Quality management and corresponding general aspects for medical devices
852ISO/TC 215 Health informatics
853ISO/TC 121 Anaesthetic and respiratory equipment
854ISO/TC 229 Nanotechnologies
855ISO/TC 274 Light and lighting
856ISO/TC 198 Sterilization of health care products
857ISO/IEC JTC 1/SC 27 IT Security techniques
858ISO/TC 222 Personal financial planning
859ISO/TC 68 Financial services
860ISO/TC 68/SC 2 Financial Services, security
861ISO/TC 68/SC 7 Core banking
862ISO/TC 176/SC 3 Supporting technologies
863ISO/TC-292 Security (incl. fraud countermeasures)
864IEC Committee titles
865SAGS-ABHS Ad-hoc Healthcare services
866IEC SEG 3 Ambient Assisted Living (AAL)
867Other
868World Health Organisation
869Organisation for Economic Co-operation and Development
870European Commissions
871

41
82
83
8726. Recommendations
873This ISO IWA will be used as a basis for exploring further international standards development activities
874around this theme. These could include the establishment of strategic groups, roadmaps, project
875committees, or standards work programmes to support aged societies.
876
877These activities will be undertaken through collaboration with Government policy-makers, and
878healthcare professionals across participating countries. It will involve co-operation with WHO, OECD,
879IEC and other international bodies who have an interest in aged societies. Initially, it could focus on
880specific global priorities that have already been identified across a number of countries, such as
881dementia care, healthy longevity expansion support care and so forth..
882
883
884

885Annexes

886Contribution from Professor Stephen Kay

887The following is a summary of comments presented by Professor Stephen Kay, ISO TC215 – Health
888Informatics – to reinforce the clarity and coherence of this IWA, with a focus on further elaborating the
889relationship between person and society. (Note) It is commonly understood by the IWA and by this
890presentation that, despite that the aged as well as the super-aged societies are defined chronologically
891and demographically at the beginning of this IWA, the intention is to focus on the adaptability of society
892to provide adequate infractructure to accommodate for its population. <Summary of comments by Prof.
893Kay, ISO TC215>
896

897Introduction
898Society, according to the Oxford English Dictionary, is the “community of people living in a particular
899country or region and having shared customs, laws, and organizations”. It is inherently a person-centric
900construct and consequently this IWA emphasizes both concepts of ‘person’ and ‘society’, exploring the
901community relationship between an aged person and the society in which they live. More specifically,
902the IWA seeks to understand the requirements for standardization that emerge from that interaction with
903respect to community-based health and care services.
904An aged society and even the super-aged society are definitions built in recent years based on ’The

42
84
85
905Ageing of Populations and its Economic and Social Implications’ by UN, originally published in 1956.
906They represent a categorization of the entire community, or population, of a country, based on what
907proportion (14% or 21% respectively) are 65 years or older. To retain these useful descriptive terms, it
908is necessary to emphasize the proportional element of the definition rather than the arbitrary figure of
90965, for there is no globally agreed definition of ‘aged’ that associates the chronological age of a person
910with this term. Furthermore, it is recognized that different regions and cultures have varying perceptions
911of what constitutes ‘aged’. W.H.O. notes that a person may be defined as aged in reference to a
912number of criteria including chronological age, functional assessment, legislation or cultural
913considerations to name but a few2.
914Figure 1

915

916
917
918
919
920
921
922
923
924
925

862 An added advantage for the IWA is that the removal of the chronological dependency gives a wider
87relevance to its recommendations, which now might satisfy a broader set of stakeholder communities.
43
88
89
926Figure 2
927
928
929
930
931
932
933
934
935
936
937
938Figure 3

939

940The presented viewpoints are illustrated in the Figures below. Figure 4 is a result of synthesizing figures
9411-3.
942Figure 1 illustrates the two main ‘people’ concepts, Person and Society, and some of the criteria that are
943explored in the IWA, providing a context and a basis for understanding the health and care requirements
944for a single person in a society.
945Figure 2 focuses on the two main concepts of Person and Society and link them to the third major
946concept, Quality of Life, which is at the centre of this IWA. Quality of Life establishes the reason for
947undertaking this IWA. Community is the natural state of a person to be in and to function as part of
948society, and shows the interdependence of person and society.

44
90
91
949Figure 3 extends the central concept of Quality of Life considerations, comprising a set of categories
950where standardization efforts can be meaningfully applied. The categories are social, health, economic,
951environmental and technological considerations. The last, technological provision, will be a major
952enabler of services that are both provided and consumed by people to enhance the quality of life,
953complementing the idea of productive ageing.
954Quality of Life considerations will need to address the requirements for sustainable approaches and also
955for innovative ones, and necessitate an on-going effort to manage the needs of personal health in an
956increasingly complex eco-system.
957The components of the illustration are generic, but all specialized needs and requirements of this IWA
958are grounded on generic concepts.
959.
960Figure 4

961

962
963
964Contribution from Dr. Nick Guldemond

965Comments and suggestions on IWA draft … circulated separately

966Key words and phrases
45
92
93
968community-based co-creation, reciprocity, (profesionals and) agencies, value-based healthcare,
969shared decision making, interoperability, health = the ability to adapt and to self-manage in the
970perspective of physical emotional and social challenges
971Reference Diagrams
972- Multi-level strategy framework (re interoperability of technology and services)
973- Causes of chronic diseases (re lifestyle diseases)
974- Disease prevention and control (re Prevention)
975- Entrepreneurial Innovation : Scientific - Technological - Business Model – Social
976- Multi-level framework for community-based co-creation of health (re reference architecture)

977

978 - ‘Services improve as a result’ of early engagement of the community people.

979 - ‘Community-based co-creation methodology’ changes systems from a work floor level.
980 - ‘This is to prevent the reinvention of the wheel and stimulate the efficiency of change.’
981 - ‘Benefits of standards’ – reducing the complexity of developing community-based
982 service and business models by a framework, making the model applicable to
983 communities in change.

984Reference Articles
985- “How should we define health?” (Dr. Huber, BMJ 2011)
986 A challenge to WHO definition of health (1948) : ‘a state of complete … well-being
987 and not merely the absence of disease or infirmity’

46
94
95
989 Change of public health landscape.
990 Proposed definition ‘health’ : the ability to adapt and to self manage…’
991 > (Ref.) WHO ‘Healthy Ageing’ (2015)
992 Healthy Ageing is the process of developing and maintaining the functional ability
993 that enables well-being in older age.
994- “Towards a new, dynamic concept of health – its operationalisation and use in public health
995 and healthcare, and in evaluating health effects of food” (Dr. Machteld Huber, 2014)
996
997
998

999Bibliography

1000 “Ageing in Cities” (OECD, Apr., 2015)”

1001 “World Report on Ageing and Health” (WHO, Oct., 2015)

1005Appendix to holistic framework of services

47
96
97