1 2015/10/28

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

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

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

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

11 1. Scope ......................................................................................................................................... 9

12 2. Terms and definitions ................................................................................................................. 9

13 3. Principles and social issues ..................................................................................................... 15

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

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

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

17 4. 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

21 5. Existing works and documents ................................................................................................ 40

22 6. Recommendations ................................................................................................................... 41

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

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

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

26
27

1
28 Foreword
29 ISO (the International Organization for Standardization) is a worldwide federation of national standards
30 bodies (ISO member bodies). ISO's technical work is normally carried out through ISO technical
31 committees in which each member body has the right to be represented. International organizations,
32 governmental and non-governmental, in liaison with ISO, also take part in the work.
33
34 In order to respond to urgent market requirements, ISO has introduced the possibility of preparing
35 documents through a workshop mechanism, outside of ISO committee structures. These documents are
36 published by ISO as International Workshop Agreements (IWA). Proposals to hold such workshops may
37 come from any source and are subject to approval by the ISO Technical Management Board, which also
38 designates an ISO member body to assist the proposer in the organization of the workshop. Although it is
39 permissible that competing International Workshop Agreements exist on the same subject, an
40 International Workshop Agreement are not to conflict with an existing ISO or IEC standard.
41
42 An International Workshop Agreement is reviewed after three years, under the responsibility of the
43 member body designated by the ISO Technical Management Board, in order to decide whether it will be
44 confirmed for a further three years, transferred to an ISO technical body for revision, or withdrawn. If the
45 International Workshop Agreement is confirmed, it is reviewed again after a further three years, at which
46 time it will be either revised by the relevant ISO technical body or withdrawn.
47
48 Attention is drawn to the possibility that some of the elements of this document may be the subject of
49 patent rights. ISO should not be held responsible for identifying any or all such patent rights.
50
51

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52 IWA 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

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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
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
Stephen Kay ISO/TC 215/WG 1 Architecture, Frameworks and Models
Susan Harker ISO/TC 159 Ergonomics

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 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)
53
54

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

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

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118 1. Scope
119
120 This International Workshop Agreement (IWA) gives guidelines to address the challenges related to
121 societies that have been unable to adapt to the ageing population. It can also be used by stakeholders as
122 a useful reference at a regional level.
123
124 It addresses health, care and social challenges (including health care needs, daily living tasks, wellbeing,
125 combating isolation, keeping safe and prevention) to ensure needs continue to be met as individuals age.
126 It also gives principles related to ethics, migration, community-based solutions, integration and
127 person-centred solutions.

128 2. Terms and definitions

129 The terms defined in this section relate specifically to this document as well as the future work carried out
130 as a consequent of this document.
131
132 Aged societies, super-aged societies
133 A country with a population where more than 14% is 65 years or older is called an ‘Aged Society’. Where
134 more than 21% of a population is 65 years or older, this is referred to as a ‘Super-aged society’.
135
136 Ageing in place
137 Meeting the desire and ability of people, through the provision of appropriate services and assistance, to
138 remain living relatively independently in the community in his or her current home or an appropriate level
139 of housing. Ageing in place is designed to prevent or delay more traumatic moves to a dependent facility,
140 such as a nursing home.

141 Source: WHO

142
143 Community
144 A group of people, often living in a defined geographical area, who may share a common culture, values
145 and norms, and are arranged in a social structure according to relationships which the community has
146 developed over a period of time. Members of a community gain their personal and social identity by
147 sharing common beliefs, values and norms which have been developed by the community in the past
148 and may be modified in the future. They exhibit some awareness of their identity as a group, and share
149 common needs and a commitment to meeting them.

150 Source: WHO

151

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

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

159
160 Dignity
161 The right of individuals to be treated with respect as persons in their own right.

162 Source: WHO

163
164 Health
165 The state of complete physical, mental, and social well-being and not merely the absence of disease or
166 infirmity. Health has many dimensions (anatomical, physiological and mental) and is largely culturally
167 defined.

168 Source: WHO

169
170 Health promotion
171 Any combination of health education and related organizational, political and economic interventions
172 designed to facilitate behavioural and environmental adaptations that will improve or protect health.

173 Source: WHO

174
175 Health system
176 The people, institutions and resources, arranged together in accordance with established policies, to
177 improve the health of the population, while responding to people's legitimate expectations and protecting
178 them against the cost of ill-health through a variety of activities, the primary intent of which is to improve
179 health. Health systems fulfil three main functions: health care delivery, fair treatment of all, and meeting
180 non-health expectations of the population. These functions are performed in the pursuit of three goals:
181 health, responsiveness and fair financing. A health system is usually organized at various levels, starting
182 at the community level or the primary level of health care and proceeding through the intermediate
183 (district, regional or provincial) to the central level.

184 Source: WHO

185

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186 Independence
187 The ability to perform an activity with no or little help from others, including having control over any
188 assistance required rather than the physical capacity to do everything oneself.

189 Source: WHO

190
191 Independent living
192 Living at home without the need for continuous help and with a degree of self-determination or control
193 over one's activities.

194 Source: WHO

195
196
197 Integrated care
198 The methods and strategies for linking and coordinating the various aspects of care delivered by different
199 care systems, such as the work of general practitioners, primary and specialty care, preventive and
200 curative services, and acute and long-term care, as well as physical and mental health services and
201 social care, to meet the multiple needs of an individual client or category of persons with similar needs.

202 Source: WHO

203
204 Integrated care / care services
205
206 The methods and strategies for linking and coordinating the various aspects of care delivered by
207 different care systems, such as the work of general practitioners, primary and specialty care,
208 preventive and curative services, and acute and long-term care, as well as physical and mental
209 health services and social care, to meet the multiple needs of an individual client or category of
210 persons with similar needs.
211 (Source: WHO Glossary)
212 (note) In this IWA document, the scope of integrated care / care services includes the independence
213 support care services as well as the interface with, but does not include, the medical care. It also
214 includes the independence support care services in the community after medical (curative) care has
215 been delivered by professionals.
216
217 Integrated health services
218 The management and delivery of health services so that clients receive a continuum of preventive and
219 curative services, according to their needs over time and across different levels of the health system.
220 (source : WHO Technical Brief No.1, 2008 "Integrated Health Services - What and Why?")

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221 (note) In this IWA document, the scope of integrated health services includes health promotion services
222 as well as the interface with medical services, but does not include the medical (preventive and curative)
223 services provided by professionals.
224
225 Integration
226 A coherent set of methods and models, on the funding, administrative,
227 organizational, service delivery and clinical levels, designed to create connectivity,
228 alignment and collaboration within the health sector.

229 Source: WHO

230
231
232 Lifestyle
233 The set of habits and customs that is influenced, modified, encouraged or constrained by the lifelong
234 process of socialization. These habits and customs include the use of substances, such as alcohol,
235 tobacco, tea or coffee; dietary habits; and exercise. They have important implications for health and are
236 often the subject of epidemiological investigation.

237 Source: WHO

238
239 Long-term care (LTC)A range of health care, personal care and social services provided to
240 individuals who, due to frailty or level of physical or intellectual disability, are no longer able to live
241 independently. Services may be for varying periods of time and may be provided in a person’s home, in
242 the community or in residential facilities (e.g. nursing homes or assisted living facilities). These
243 people have relatively stable medical conditions and are unlikely to greatly improve their level of
244 functioning through medical intervention.
245 Source: WHO

246
247 Personal care
248 Functions and activities normally associated with body hygiene, nutrition, elimination, rest and walking,
249 which enables an individual to live at home in the community.

250 Source: WHO

251
252 Prevention
253 This is aimed at promoting health, preserving health and restoring health when it is impaired and to
254 minimize suffering and distress.
255 There are various levels of prevention:

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

266 Source: WHO

267
268 Programme
269 An organized collection of activities directed towards the attainment of defined objectives and targets
270 which are progressively more specific than the goals to which they contribute.

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

272 Source: WHO

273
274 Provider
275 An individual health care professional, a group or an institution that delivers care services.

276 Source: WHO

277
278 Quality of Life (QoL)
279 The product of the balance between social, health, economic and environmental conditions which affect
280 human and social development. It is a broad-ranging concept, incorporating a person’s physical health,
281 psychological state, level of independence, social relationships, personal beliefs and relationship to
282 salient features in the environment. As people age, their quality of life is largely determined by their ability
283 to access needed resources and maintain autonomy and independence.

284 Source: WHO

285
286 Safety
287 A judgment of the acceptability of risk (a measure of the probability of an adverse outcome and its
288 severity) associated with a given situation or setting.

289 Source: WHO

290
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291 Salutogenesis / salutogenic
292 A theory that puts more importance on people’s resources and capacity to create health than the
293 classic focus on risks, ill health and disease, with the ability called sense of coherence (SOC),
294 composed of the elements of comprehension, manageability and meaningfulness, enabling the use
295 of resources available to solve the problem.
296 (source: Journal of Epidemiology and Community Health http://jech.bmj.com/content/59/6/440.full)
297 (note) The theory was introduced by Aaron Antonovsky. It sees health as a movement in a
298 continuum between total ill health and total health.
299
300 Specialist
301 A health professional who is specially trained in a certain branch of his/her profession related to specific
302 services or procedures.

303 Source: WHO

304
305 Standard
306 A quality measure or reference point established as a rule or model by authorities, custom or general
307 consent, against which things can be evaluated or should conform.

308 Source: WHO

309
310 System
311 A network of interdependent components that work together to attain the goals of the complex whole.

312 Source: WHO

313
314 Systemization
315 ALTERNATIVE: Systems Approach
316 A school of thought evolving from earlier systems analysis theory and advocating that virtually all
317 outcomes are the result of systems rather than individuals. In practice, systemization is characterized by
318 attempts to improve the quality and/or efficiency of a process through improvements to the system.

319 Source: WHO

320
321 Well-being
322 A dynamic state of physical, mental and social wellness; a way of life which equips the individual to
323 realize the full potential of his/her capabilities and to overcome and compensate for weaknesses; a
324 lifestyle which recognizes the importance of nutrition, physical fitness, stress reduction, and
325 self-responsibility. Well-being has been viewed as the result of four key factors over which an individual
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326 has varying degrees of control: human biology, social and physical environment, health care organization
327 (system), and lifestyle.

328 Source: WHO

329 3. Principles and social issues

330
331 3.1 Principles
332
333 3.1.1 General
334 This clause provides guidance on five principles of solutions to health, care and social challenges related
335 to aged society.
336 In order to achieve aged societies where people are able to stay healthy and active for as long as
337 possible and can continue to live in their communities with peace of mind and dignity, even when they
338 become frail, multiple stakeholders of our society such as states, local governments, non-profit
339 organizations, enterprises, and individuals, should adhere to the following five principles.

340 3.1.2 Dignity

341 The principle is; multiple stakeholders should hold firmly the viewpoint of “respect for human dignity
342 throughout lifecycle”.
343
344 Dignity, the core value of human rights, is supported by individuals’ independence and positive
345 relationship with society. Although it is often overlooked due to the physical and mental changes that
346 accompany ageing, the respect for dignity should be upheld throughout people’s lives.

347 3.1.3 Productive ageing

348 The principle is; multiple stakeholders should adapt a “productive ageing approach” as the basis of their
349 relevant activities.
350
351 All individuals should be enabled to pursue a healthy life for as long as possible, as well as the
352 opportunities to work and to participate in social activities. At the same time, they should be able to
353 endeavour to maintain the productive relationship with the people around them regardless of frailty, while
354 all the people around should also help and provide the opportunities for them to continue to be
355 productive.

356 3.1.4 Community-based services

357 The principle is; support and services such as health care, long-term care, preventive actions, and
358 support for activities of daily life, all of which are necessary for people to be able to fully experience
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359 productive ageing, must be rooted in communities to secure user accessibility and to enhance provider
360 responsibility and coherence.
361
362 These support and services are meaningless unless they are easily accessible as necessary in daily life.
363 Providers of these support and services should pursue active engagement with their stakeholders in
364 communities.

365 3.1.5 Systemization with people at the centre

366 The principle is; support and services mentioned above should be person-centred and systemized so
367 that they can be provided efficiently in a seamless and flexible manner in the community with users of
368 such services being at the centre of the system. Support and services should be flexible and adaptable to
369 the required needs varying during a person’s lifecycle.
370
371 These support and services should not be provided in an uncoordinated and inflexible manner divided in
372 specialty silos.

373 3.1.6 Pursuit of innovation for sustainability

374 The principle is; both individual parts of systems and entire systems of support and services (mentioned
375 previously) should be continuously improved by pursuit of innovation based on evidence, including those
376 from the salutogenic approach, aiming to achieve sustainable harmonization of approaches from
377 individual users and society.
378
379 Health and care services and their systems should be continuously innovated to be more efficient and of
380 better quality at all times in a sustainable manner, supported by new technology and scientific knowledge
381 as well as the social innovation including the behavioural changes of not only the aged but also the
382 younger generation.
383

384 3.2 Social issues

385 3.2.1 General

386 This section outlines some of the aspirations for aged societies in the future. It also covers some of the
387 challenges and barriers to meeting these aspirations that have been identified. It is based upon some
388 research that was undertaken with carers, nurses and members of the public in the UK during 2014, as
389 part of a framework for standards to support innovation in long term care (“A framework for standards to
390 support innovation in long term care, BSI, September2014”)..
391

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392 3.2.2 Future provisions for aged societies

393 3.2.2.1 Common principles

394 This section outlines some of the aspirations for aged societies in the future.
395
396 There are common principles for provision of products and services to of aged societies, which are
397 focused on providing health and social care needs in the home. Care and support should be:
398 - tailored to meet the realistic wishes of the recipient;
399 - be arranged in a timely manner;
400 - provided in the home (where desired and if possible);
401 - provide flexibility over timings for receiving care services;
402 - be well co-ordinated by someone;
403 - who knows the recipient and understands their needs;
404 - and delivered by a team who the recipient trusts.
405
406 Specific requirements for aged societies tend to increase as a person’s physical and/or mental health
407 declines. Keeping physically active and avoiding loneliness are fundamental aspects to ensuring
408 wellbeing. Communities are an invaluable source of support as the health and care needs of an
409 individual change. The public need to be able to access medical and lifestyle services easily, to ensure a
410 continued positive outlook on life. As personal care requirements increase, the focus often moves
411 towards accomplishing routine day-to-day living tasks in the home. With cognitive impairments, planning
412 financial and personal security becomes a greater priority, along with the ever-changing contexts and
413 technologies surrounding financial transactions, and economic changes.
414
415 Changes in physical and/or mental capabilities are often predicted by key milestones that result in
416 greater challenges, such as restrictions on mobility, memory loss, or death of a partner. An increase in
417 single people (as opposed to couples), or single parent families may encourage greater independence
418 for individuals in the future and that the public is now becoming more aware of availability and choice of
419 long term care services in the home.

420 3.2.2.2 Medical needs

421 Medical needs include the provision and review of medical prescriptions, and the diagnosis and
422 management of acute conditions. Nursing and social care requirements may include administering
423 medication at the right time and ensuring appropriate equipment and adaptations are in place.
424
425 The public should have opportunities to receive health and social care in settings beyond traditional
426 surgeries, clinics and hospitals. These could include:

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427 - ‘24/7 one-stop’ healthcare centres with no waiting times, offering a full range of services;
428 - drop-in centres for health and other community services in shops and pharmacies;
429 - clinics in the high street or community centres;
430 - physiotherapists in leisure centres;
431 - and where possible, services (such as podiatry, ophthalmology dentistry and physiotherapy) in
432 the home.
433
434 Aged societies should include support that is well co-ordinated across medically qualified professionals.
435 Improvements to ‘out of hours’ services will be required, and a greater willingness of services to visit the
436 home, or other locations.
437
438 Systems for making medical appointments will need to become simpler and remote consultations (e.g.
439 via Skype) will need to become routine. Healthcare professionals should be able to spend more time
440 with individuals to assess and review their needs, wishes and aspirations. Consumers of healthcare
441 services should be able to undertake regular reviews involving themselves, their family, medical and care
442 professionals to discuss their overall wellbeing and satisfaction.

443 3.2.2.3 Personal care

444 Personal care is related to the ability of a person to dress, bathe, go to bed and get up, either individually
445 or with a third party, and the associated moving and lifting of people. It can apply in the home, in an
446 institution or another location (e.g. on a holiday). Personal care needs to fit in with the cultural normality
447 and attitudes provided by the family or community. An individual should always have a choice of carer
448 and should expect consistency and competence.
449
450 In the future, there should be greater time provided for carers to spend with individuals, to manage their
451 needs as defined by them, rather than being bound by the constraints of workload. There should be
452 flexibility around the times of day for when tasks are carried out (e.g. bathing and eating at appropriate
453 times). Housing should be developed and adapted so that it is easier to provide long term care. Digital
454 technologies can play a part in providing services or requesting assistance.
455
456 The public should be involved in early discussions about preferences for end-of-life care, including the
457 option of living wills and spiritual support. Professional support should be provided by a consistent team
458 that can all work together. Greater support and counselling should be provided to spouses and offspring
459 for a sustained period after a loved one has passed away.

460 3.2.2.4 Daily living tasks

461 Day-to-day living tasks include activities such as cooking, shopping, housework, laundry, gardening and

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462 transport. It requires the provision of suitable individuals and services to allow this to happen effectively.
463
464 Individuals and carers should not be time-pressured when undertaking these tasks. Where possible, the
465 wider community could become involved in providing suitable services, and consideration should be
466 given to the use of ‘time bank’ models for providing care.
467
468 Private businesses should recognize the opportunity for individuals to outsource some of their daily living
469 tasks (e.g. laundry services could be undertaken by supermarkets). Some tasks could be completed by
470 electronic means, but the solutions would need to be cost-effective. Service providers should become
471 more aware of the needs of aged societies and offer services that are specifically designed for older
472 people. Communities should offer better transport options, including dedicated car parking spaces.
473
474 There are some daily tasks that are considered important by people, such as gardening, but are often
475 seen as being less important in terms of overall care packages. These tasks should become routinely
476 available to those who want them.

477 3.2.2.5 Maintaining relationships and community involvement

478 It is important to ensure an individual’s inclusion in appropriate exercise, leisure and spiritual activities,
479 that allow them to enjoy their life, as well as allowing them to give something back to the community if
480 desired. Activities can involve befriending services, and a role for people to support others across their
481 community. Aged societies and their families see the value in paying for activities so that they enjoy life,
482 but cost can sometimes be a barrier.
483
484 Aged societies consist of intelligent, experienced adults with a right to make their own choices for
485 socializing and for leisure activities (rather than having certain activities forced upon them). In the future,
486 broader activities should become available so that there is something for everybody to enjoy. Leisure
487 centres should run classes and programmes for different levels of fitness. For those unable or unwilling
488 to participate, technology currently used by the digital gaming industry could provide a suitable
489 alternative. Access to pets is also regarded as an important aspect of companionship.
490
491 It is important to provide companionship, and help people with all of their communication needs, from
492 physical meetings to remote contact, both inside and outside of the home. Family and friends are often
493 the main source for this support, however, there is a wider role for the community. Businesses and
494 professionals may need to encourage socializing aspects (e.g. by provision of suitable transport).
495 Technology is seen by many people as an enabler to bring people together who want to be connected
496 (e.g. video calls).

19
497 3.2.2.6 Keeping safe
498 Ensuring people are safe inside and outside of the home is widely recognized as an important aspect of
499 assuring an aged society against unusual, criminal or adverse events. This can include protection from
500 robbery, fire and extreme weather conditions.
501
502 In the home, social alarms and CCTV are well known and effective devices for monitoring and alerting for
503 assistance, should an incident occur. However, these come at a cost, do not routinely work outside the
504 home and can be set off in error. Some neighbourhoods provide schemes to prevent unwanted visitors to
505 the doorstep, and to keep a watch on each other.
506
507 Outside the home, certain technologies have been applied to assist those with cognitive impairments, but
508 these are not in mainstream use. Commercial organizations are training their staff to become more
509 aware of societal issues, which demonstrates the start of a move towards tailoring services towards the
510 needs of society.
511
512 In the future, digital technology could provide a way of integrating information from around the home,
513 along with personal data (e.g. location) to ensure that a person is safe and secure.

514 3.2.3 Challenges and barriers to creating new approaches

515 3.2.3.1 Person-centred care provision

516 Challenges relating to the provision of services that are joined up, and centred on the user include:
517 - achieving an early diagnosis (particularly where this can qualify a person for extra support);
518 - providing immediate access to new products and services, when a sudden deterioration in health
519 is experienced;
520 - communication and sharing of information between different professionals and agencies.
521
522 One of the barriers to achieving this includes the fragmentation of different agencies, and a protective
523 attitude towards data sharing and communication. The loss of continuity between patients and trusted
524 professionals, when they move to other jobs also hindered good person-centric provision.

525 3.2.3.2 Education and training

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

20
530 3.2.3.3 Maintaining relationships and community involvement
531 The barriers to maintaining social relationships and involvement in the community can include:
532 - a lack of variety of suitable activities to suit all cultures, interest, levels of education and abilities;
533 - poor transport options and a lack of different environments that can be accessed;
534 - a lack of concessionary rates;
535 - clarity in identifying suitable activities, particularly those with cognitive impairments.

536 3.2.3.4 Developing the home environment

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

542 3.2.3.5 Interface with technology

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

546 3.2.3.6 Economic aspects

547 The public should be encouraged to plan ahead for their future needs, rather than waiting for a
548 deterioration in their health and either being unwilling to seek assistance, or assuming that help would be
549 provided automatically. This will help to reduce difficulties when there is a sudden change, and allow for
550 better outcomes. However, some people think there is often a lack of reward for those who have
551 carefully planned their future, in comparison with those that haven’t and this can cause resentment.
552
553 Systems and services need to be developed that are seen as fair and affordable, and make sense to the
554 people who use them. Where funding is provided, it should allow users to freely select products and
555 services that meet their needs rather than only allow access to a pre-established specification.
556 Self-management of funding should be made as simple as possible for users in order to allow them to
557 personalize their choices for care and services.

558 3.2.3.7 Societal attitudes

559 One of the key challenges to creating an effective aged society relates to building more caring and
560 respectful attitudes within individuals and businesses. Families are not always available to provide
561 support, and other people could provide more practical support, such as visiting neighbours, undertaking
562 work experience, or providing help with physical demanding tasks.
563

21
564 Whilst individual professional carers are valued, there is a perception that some organizations only have
565 an interest in making money. The perception of these organizations needs to be enhanced, in order to
566 attract more high calibre and motivated people to work for them.

567

568 3.3 Basic approach

569 3.3.1 Health and care in relation to ageing

570 The relationship of health and care with ageing is shown in the following Figure.
571
572
573 Figure 1 – Health maintenance and care through the life cycle

574
575
576 The 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.
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.

22
577 Independence levels can deteriorate due to various diseases such as cerebral vascular illnesses as well
578 as the progress of age-related frailty. These diagrams are the outcome of tracing 6,000 elderly people in
579 Japan over a twenty-year period. 20% of males either die of diseases or go into severe levels of
580 long-term care before reaching 70 years of age. Those who survive this stage follow slightly different
581 frailty progress patterns depending on whether they are male or female.
582
583 The survey also showed that for females, younger generations had a higher degree of connectivity, while
584 on the other hand, for males, the younger generations had less mutual connectivity than older
585 generations. Increasing loneliness for men is a big concern. With males and females totalled, 80% of
586 people start losing independence steadily from their mid-70s. There are three major imminent actions
587 that need to be encouraged1.
588
589 The first action is to shift the starting age of deterioration forward even 2 or 3 years. Extension of healthy
590 age and the independence period, enabled by physical and cognitive functions, benefits not only older
591 people but community and society as a whole.
592
593 The second action is to create the right infrastructure for the ‘ageing of the aged population’. As the
594 increase of frail older people is inevitable, social infrastructure to embrace and support them should be
595 designed and constructed. This includes hard infrastructure, such as housing and transportation as well
596 as soft infrastructure such as medical care, long-term care, pension systems, etc.
597
598 The third action is to implement the measures to increase the connectivity within, and coherence of, the
599 community where the post-retirement generation spend the rest of their later life.

600 3.3.2 Stages of health promotion and care provision

601 Promotion of health, prevention of diseases and frailty, and the degrees of providing care can be
602 approached in four stages. Each stage has objectives that need to be achieved, with certain expected
603 effects, and should have the relevant international standards in line with the established objectives. The
604 four stages of approach are:
605 1. Prevention of Lifestyle Diseases,
606 2. Prevention of Frailty,
607 3. Care for Assisting Independence, and
608 4. Care for Living in the Community.
609
610 The objective of preventing lifestyle diseases and frailty is to prolong healthy life expectancy. It aims to

1 ‘Platinum Vision Handbook’, Hiroko Akiyama

23
611 enable people of all ages to live independently from care or hospitals. Its expected effects are the overall
612 improvement of social efficiency, including the reduction of costs of medical and long-term care both for
613 the individual and for the society.
614
615 The objective of providing care for assisting independence is to improve the ADL, and its expected effect
616 is the minimization of long-term care costs. Finally, the objective of providing care for living in the
617 community is to improve the quality of life (QOL) of the people who reach this stage. Its expected effect is
618 the improvement of long-term care cost efficiency.
619
620 The following matrices show details of the above-mentioned concepts.

621 Table 1 – The objectives and effects for the 4 stages of approach
Four Stages of Approach Objectives Effects
Health Promotion and Prolongation of Healthy Life Improvement of Social
Prevention of Lifestyle Expectancy (1) Efficiency and Reduction of
Diseases Medical Costs
Prevention of Frailty Prolongation of Healthy Life Improvement of Social
(incl. dementia) Expectancy (1) Efficiency and Reduction of
Medical and Long-Term Care
Costs
Independence Support Care Improvement of Functional Improvement of Long-Term
(incl. dementia) Capabilities and Abilities Care Cost Efficiency
Long-term Care in the Improvement of QOL (2) Improvement of Long-term
Community Care Cost Efficiency
(incl. dementia)
(1) Influencing factors:

a. Nutrition / Malnutrition

b. Injury prevention

c. Physical activity

d. Mental activity (life-long learning)

e. Social connectedness (inclusion/participation)

(2) According to WHO definition (WHOQOL)

622 Each of the four stages of approach can contain three levels of international standards (see Table 2).
623 First, the social system level, second, the business system level, and third, services and products level.
624 The services and products are provided by the business system, and the business system is supported
625 by, and is within the framework of, the social system.
626
24
627 Table 2 – The three levels of implementation in relation to the 4 stages of approach (see Cube and
628 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)
Community (see Box 1) Level by Criteria
(incl. dementia) (see Box 2)
Long-term Care
Program
Assessment by
Care Data
629
630 On the Social Level (Table 2) two categories of social plans are to be developed. The first category
631 consists of two stages of Community-based Health Support Plans. The second category consists of two

25
632 stages of Community-based Care Support Plans (see Box 1). The Social Level is lead mainly by
633 municipal governments to provide health and care services needed in the communities.
634
635 On the Projects Level (Table 2) three categories of standards are to be developed. First is the
636 standardization of specific activities such as criteria establishment (health screening criteria, frailty
637 screening criteria, and evaluation criteria of long-term care) (see Box 2). The second is program
638 development (health promotion program, independence support program, and long-term care program).
639 The third is the assessment of the outcome by data utilization (health data, frailty data, ADL data, care
640 data, etc.). These standardization efforts are repeated in cycles of ‘criteria establishment > programs
641 development > assessment > criteria review’. The projects Level is carried out mainly by the multiple
642 services providers based on the needs of the people in the communities.
643
644 On the Services and Products Level (Table 2) the standardization of a variety of services and products is
645 developed in accordance with the objectives and effects in Table 1. The Services and Products Level is
646 achieved by the specific services delivered to the people who are in need of them.
647
648 All three levels and four stages are illustrated in the Cube and Matrix in Figure 5.
649

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

In 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
plan, 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
system are: healthcare, long-term care, prevention, housing and livelihood support
services.

26
650

651

652

653

654

655

<Box 2> Evaluation of long-term care

656
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
657
of needed LTC is specifically measured, and also the amount and categories of
658
appropriate LTC to be provided are judged.
659
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
660 3.3.3 Healthy Ageing

661
662
663
664
665 Figure 3 Health systems and social care
666 (World Report on Ageing and Health, WHO, 2015)
667
668 Healthy ageing, according to WHO, is ‘the process of developing and maintaining the functional ability
669 that enables well-being in older age’. The functional ability comprises the health-related attributes that
670 enable the people to be and to do what they have reason to value. It is made up of intrinsic capacity of
671 the individual, relevant environmental characteristics and the interactions between the individual and
672 these characteristics. Intrinsic capacity is the composite of all the physical and mental capacities of an
673 individual. Environments include, from the micro- to macro-level, components such as home,
674 communities, society, health and social policies, societal attitudes and values, systems that support the
675 people, and the services provided to them.
676
677
678
679
680
681
682
683

28
684
685
686

687

688 Health services:

689
690
691

692 Long-term care:

693
694
695

696 Environments:
697
698 Figure 4 A public-health framework for Healthy Ageing: opportunities for public-health action
699 across the life course
700 (World Report on Ageing and Health, WHO, 2015)
701
702 Building and maintaining the intrinsic capacity, and fostering the functional ability,
703 to realize the optimal trajectory of individuals, we can consider the approaches from three common
704 periods - high and stable capacity, declining capacity and significant loss of capacity. In each period of
705 this continuum, supportive measures to help achieve this objective can be provided in three aspects as
706 shown in the diagram - health services, long-term care and environments.
707

708 3.3.4 Reference architecture

709 3.3.4.1 The structure of holistic framework of services

710
711
712 Figure 5 – A possible structure of IWA and the services
713

29
714
715
716 Integrated health services provide health check and guidance, and health promotion services including
717 social participation. Integrated care services provide independence/autonomy support and social care
718 services in coordination with medical care services. To support these services, a social infrastructure
719 system would provide the housing, community, economy, technology and innovation.
720
721 3.3.4.2 The cube and matrix
722 The Cube below shows the relationship between the three-level approach to four stages of ageing and
723 the Holistic Framework of Services.
724

30
725
726 Figure 6 – The Cube
727 The five principles, explained earlier, are the overarching background for all dimensions of approach,
728 stages and services depicted on the Cube. The three-level approach and four stages of ageing depicted
729 on the top face and the side face of the Cube respectively, as well as the relationship between these two
730 dimensions are shown earlier in Tables 1 and 2. The ‘criteria > program > assessment’ cycle is
731 particularly important Projects Level, as referred to in Table 2.
732
733 The Holistic Framework of Services is shown in the previous section. Its main service categories are
734 health services, care services and social infrastructure. A further breakdown of services is shown in
735 Section 4. It should be noted that this framework itemizes services extensively but is not exclusive. This
736 framework is able to develop continuously into the future.
737
738 The Cube (3 levels x 4 stages x 3 genres) is a cabinet to organize the services (currently 43+) listed in
739 section 4. The services are a continuum that needs to be linked and integrated seamlessly to optimize
740 efficiency and effectiveness, person-centred, with the 5 principles in place. The principles are also the
741 prerequisites that need to pervade all the check cycles of criteria – program – assessment.
742 WHO’s newest definition of ‘Healthy Ageing’ should be the overarching guiding principle as well.
743
744 The following Matrix indicates the inter-relationship of specific services of the Holistic
745 Framework of Services with the three levels of approach and four stages of ageing.
746

31
 Integrated Health Services (See Appendix for Services (*))

Health Check and Guidance Services

Health Health “Data Health Healthcar Health

Check and Check and Health” Guidance e Data Check
Guidance Guidance Project Services Trust Devices
Services Services by based on Services
on Non- Profession Health (*)
A B profession als Informatio
al Level n (*)
(*)

1 Social 1 Prevention of
● ●
Level Lifestyle Disease

1 Social 2 Prevention of
● ●
Level Frailty

1 Social 3 Independence
●
Level Support Care

4 Long-term
1 Social
Care in the ●
Level
Community
2 Projects 1 Prevention of
● ● ● ●
Level Lifestyle Disease

2 Projects 2 Prevention of
● ● ● ●
Level Frailty

2 Projects 3 Independence
● ●
Level Support Care
4 Long-term
2 Projects
Care in the ● ●
Level
Community
3
Services& 1 Prevention of
●
products Lifestyle Disease
Level
3
Services& 2 Prevention of
●
products Frailty
Level
3
Services& 3 Independence
●
products Support Care
Level
3
4 Long-term
Services&
Care in the ●
products
Community
747 Level

748

32
749

Health Promotion Services

Walking Sleep Care Exercise/F Diet and Oral Care Beauty Tourism
Support Services itness Dietary Services Services Services
A B Services Services Support
Services
1 Social 1 Prevention of
Level Lifestyle Disease
1 Social 2 Prevention of
Level Frailty
1 Social 3 Independence
Level Support Care
1 Social 4 Long-term Care
Level in the Community
2 Projects 1 Prevention of
Level Lifestyle Disease
2 Projects 2 Prevention of
Level Frailty
2 Projects 3 Independence
Level Support Care
2 Projects 4 Long-term Care
Level in the Community
3
Services&pr 1 Prevention of
● ● ●
oducts Lifestyle Disease
Level
3
Services&pr 2 Prevention of
● ● ● ● ● ● ●
oducts Frailty
Level
3
Services&pr 3 Independence
● ● ● ● ● ● ●
oducts Support Care
Level
3
Services&pr 4 Long-term Care
● ● ● ●
oducts in the Community
750 Level
751

33
 Social Participation

Job Hobbies,
Matching, Community
Volunteer/ Activities
A B Part-time
Work

1 Social 1 Prevention of
Level Lifestyle Disease

1 Social 2 Prevention of
●
Level Frailty

1 Social 3 Independence
●
Level Support Care

4 Long-term
1 Social
Care in the
Level
Community

2 Projects 1 Prevention of
Level Lifestyle Disease

2 Projects 2 Prevention of
● ●
Level Frailty

2 Projects 3 Independence
● ●
Level Support Care
4 Long-term
2 Projects
Care in the ●
Level
Community
3
Services& 1 Prevention of
products Lifestyle Disease
Level
3
Services& 2 Prevention of
products Frailty
Level
3
Services& 3 Independence
products Support Care
Level
3
4 Long-term
Services&
Care in the
products
Community
752 Level

34
 Integrated Care Services
Independence Support Services

Welfare Care/Com Home ICT Continence Toileting Care Living Independence/ Guardian
Equipment municatio Care and Bathing Foods and Support Rehabilitation of Adults
Providing n Robots Services (*) Services Delivery Services Assistance
Services (*) Services (Watching/ Care Services
A B Counseling
/Housekeep
ing…)

1 Prevention
1 Social
of Lifestyle
Level
Disease

1 Social 2 Prevention
Level of Frailty

3
1 Social
Independence ●
Level
Support Care

4 Long-term
1 Social
Care in the ●
Level
Community

1 Prevention
2 Projects
of Lifestyle
Level
Disease
2 Projects 2 Prevention
●
Level of Frailty
3
2 Projects
Independence ● ● ● ● ●
Level
Support Care
4 Long-term
2 Projects
Care in the ● ● ● ● ●
Level
Community
3
1 Prevention
Services&
of Lifestyle
products
Disease
Level
3
Services& 2 Prevention
products of Frailty
Level
3
3
Services&
Independence ● ● ● ●
products
Support Care
Level
3
4 Long-term
Services&
Care in the ● ● ● ●
products
Community
753 Level
754

35
 Long-term Care Services
A B House Day Short Stay Small- Periodic/on
Visitation Services Services scale, going visits
Services Multi- by a long-
functional term care
at Home provider or
Care nurse
Services
1 Prevention
1 Social
of Lifestyle
Level
Disease
1 Social 2 Prevention
Level of Frailty
3
1 Social
Independence
Level
Support Care
4 Long-term
1 Social
Care in the
Level
Community
1 Prevention
2 Project
of Lifestyle
Level
Disease
2 Project 2 Prevention
Level of Frailty
3
2 Project
Independence ● ●
Level
Support Care
4 Long-term
2 Project
Care in the ● ●
Level
Community
3
1 Prevention
Services&
of Lifestyle
products
Disease
Level
3
Services& 2 Prevention
products of Frailty
Level
3
3
Services&
Independence ● ● ●
products
Support Care
Level
3
4 Long-term
Services&
Care in the ● ● ●
products
Community
755 Level

36
 Social Infrastructure
Social Infrastructure

Risk Insurance Financial Housing City Planning Community ICT

Management Services Services and Coordination Services
A B (life insurance, Management
LTC insurance)

1 Social 1 Prevention of
● ●
Level Lifestyle Disease

1 Social 2 Prevention of
● ● ●
Level Frailty

1 Social 3 Independence
● ● ● ●
Level Support Care

1 Social 4 Long-term Care

● ● ● ●
Level in the Community

2 Projects 1 Prevention of
● ● ● ●
Level Lifestyle Disease
2 Projects 2 Prevention of
● ● ● ● ●
Level Frailty
2 Projects 3 Independence
● ● ● ● ● ●
Level Support Care
2 Projects 4 Long-term Care
● ● ● ● ● ●
Level in the Community
3
Services& 1 Prevention of
products Lifestyle Disease
Level
3
Services& 2 Prevention of
products Frailty
Level
3
Services& 3 Independence
●
products Support Care
Level
3
Services& 4 Long-term Care
●
products in the Community
756 Level

37
 Transportation Home Delivery Home Protection Fostering of Social Community
Support Services Security from Experts and Interaction Information
A B Services Services Fraud Procuring of Services Services
Labor

1 Social 1 Prevention of
Level Lifestyle Disease

1 Social 2 Prevention of
Level Frailty

1 Social 3 Independence
● ●
Level Support Care

1 Social 4 Long-term Care

● ●
Level in the Community
2 Projects 1 Prevention of
● ●
Level Lifestyle Disease
2 Projects 2 Prevention of
● ● ●
Level Frailty
2 Projects 3 Independence
● ● ● ● ●
Level Support Care
2 Projects 4 Long-term Care
● ● ● ● ●
Level in the Community
3
Services& 1 Prevention of
products Lifestyle Disease
Level
3
Services& 2 Prevention of
products Frailty
Level
3
Services& 3 Independence
● ●
products Support Care
Level
3
Services& 4 Long-term Care
● ●
products in the Community
757 Level

758

759 4. Holistic framework of services

760 In the delivery of holistic health and care services to any society, consideration has to be given to the
761 needs of individuals as well as how the range of services are connected to each other. This framework
762 includes varietal services relevant to health and care in aged societies. It illustrates the diversity of
763 service sectors involved, many of which will be catering to a wide range of age groups. The list is not
764 complete nor exclusive. See Appendix for Individual Services.
38
765 Integrated health services (*See Appendix for services)
766 Health Check and Guidance Services
767 Health Check and Guidance Services on Non-professional Level
768 Health Check and Guidance Services by Professionals
769 ‘Data Health’ Project
770 Health Guidance Services based on Health Information
771 Healthcare Data Trust Services
772 Health Check Devices
773 Health Promotion Services
774 Walking Support Services
775 Sleep Care Services
776 Exercise/Fitness Services
777 Diet and Dietary Support Services
778 Oral Care Services
779 Beauty Services
780 Tourism Services
781 Social Participation
782 Job Matching, Volunteer/Part-time Work
783 Hobbies, Community Activities

784 Integrated care services

785 Independence Support Services
786 Welfare Equipment Providing Services
787 Care/Communication Robots
788 Home ICT
789 Continence Care Services
790 Toileting and Bathing Services
791 Care Foods and Delivery Services
792 Living Support Services (watching, counselling, housekeeping, etc.)
793 Independence/Rehabilitation Assistance Care Services
794 Guardian of Adults
795 Long-term Care Services
796 House Visitation Services
797 Day Services
798 Short Stay Services
799 Small-scale, Multi-functional at Home Care Services
800 Periodic/on-going visits by a long-term care provider or nurse
39
801 Social infrastructure
802 Risk Management*
803 Insurance Services (life insurance, LTC insurance)
804 Financial Services
805 Housing
806 City Planning and Management
807 Community Coordination
808 ICT Services
809 Transportation Support Services
810 Home Delivery Services
811 Home Security Services
812 Protection from Fraud
813 Fostering of Experts and Procuring of Labour
814 Social Interaction Services
815 Community Information Services
816 …..
817

818 5. Existing works and documents

819 ISO Committee titles
820 ISO/TC 71/SC 7 Maintenance and repair of concrete structures
821 ISO/TC 121/SC 3 Lung ventilators and related equipment
822 ISO/TC 43 Acoustics
823 ISO/IEC JTC 1 ISO/IEC Joint Technical Commitee for Information Technology
824 ISO/IEC JTC 1/SC 28 Office equipment
825 ISO/IEC JTC 1/SC 35 User interfaces*ISO/CEI JTC 1/SC 35 Interfaces utilisateur
826 ISO/TC 159 Ergonomics
827 ISO/TC 159/SC 5 Ergonomics of the physical environment
828 ISO/TC 159/SC 3 Anthropometry and biomechanics
829 ISO/TC 94 Personal safety - Protective clothing and equipment
830 ISO/TC 22 Road vehicles
831 ISO/TC 59/SC 16 Accessibility and usability of the built environment
832 ISO/TC 43/SC 1 Noise
833 ISO/TC 225 Market, opinion and social research
834 ISO/TC 213 Dimensional and geometrical product specifications and verification
835 ISO/TC 233 Societal security
40
836 ISO/TC 37 Terminology and other language and content resources
837 ISO/TC 147/SC 5 Biological methods
838 ISO/IEC JTC 1/SC 6 Telecommunications and information exchange between systems
839 ISO/TC 268/SC 1 Smart community infrastructures
840 ISO/TC 268 Sustainable development in communities
841 ISO/TC 215 Health informatics
842 ISO/TS 13131:2014 Health informatics -- Telehealth services -- Quality planning guidelines
843 ISO/TC 173/SC 1 Wheelchairs
844 ISO/TC 249 Traditional Chinese medicine
845 ISO/TC 210 Quality management and corresponding general aspects for medical devices
846 ISO/TC 215 Health informatics
847 ISO/TC 121 Anaesthetic and respiratory equipment
848 ISO/TC 229 Nanotechnologies
849 ISO/TC 274 Light and lighting
850 ISO/TC 198 Sterilization of health care products
851 ISO/IEC JTC 1/SC 27 IT Security techniques
852 ISO/TC 222 Personal financial planning
853 ISO/TC 68 Financial services
854 ISO/TC 68/SC 2 Financial Services, security
855 ISO/TC 68/SC 7 Core banking
856 ISO/TC 176/SC 3 Supporting technologies
857 ISO/TC-292 Security (incl. fraud countermeasures)
858 IEC Committee titles
859 SAGS-ABHS Ad-hoc Healthcare services
860 IEC SEG 3 Ambient Assisted Living (AAL)
861 Other
862 World Health Organisation
863 Organisation for Economic Co-operation and Development
864 European Commissions
865

866 6. Recommendations
867 This ISO IWA will be used as a basis for exploring further international standards development activities
868 around this theme. These could include the establishment of strategic groups, roadmaps, project
869 committees, or standards work programmes to support aged societies.
870
41
871 These activities will be undertaken through collaboration with Government policy-makers, and healthcare
872 professionals across participating countries. It will involve co-operation with WHO, OECD, IEC and other
873 international bodies who have an interest in aged societies. Initially, it could focus on specific global
874 priorities that have already been identified across a number of countries, such as dementia care, healthy
875 longevity expansion support care and so forth..
876
877
878

879 Annexes
880
881 Contribution from Professor Stephen Kay
882
883 The following is a summary of comments presented by Professor Stephen Kay, ISO TC215 – Health
884 Informatics – to reinforce the clarity and coherence of this IWA, with a focus on further elaborating the
885 relationship between person and society. (Note) It is commonly understood by the IWA and by this
886 presentation that, despite that the aged as well as the super-aged societies are defined chronologically
887 and demographically at the beginning of this IWA, the intention is to focus on the adaptability of society to
888 provide adequate infractructure to accommodate for its population. <Summary of comments by Prof.
889 Kay, ISO TC215>
890

891 Introduction
892 Society, according to the Oxford English Dictionary, is the “community of people living in a particular
893 country or region and having shared customs, laws, and organizations”. It is inherently a person-centric
894 construct and consequently this IWA emphasizes both concepts of ‘person’ and ‘society’, exploring the
895 community relationship between an aged person and the society in which they live. More specifically,
896 the IWA seeks to understand the requirements for standardization that emerge from that interaction with
897 respect to community-based health and care services.
898 An aged society and even the super-aged society are definitions built in recent years based on ’The
899 Ageing of Populations and its Economic and Social Implications’ by UN, originally published in 1956.
900 They represent a categorization of the entire community, or population, of a country, based on what
901 proportion (14% or 21% respectively) are 65 years or older. To retain these useful descriptive terms, it
902 is necessary to emphasize the proportional element of the definition rather than the arbitrary figure of 65,
903 for there is no globally agreed definition of ‘aged’ that associates the chronological age of a person with
904 this term. Furthermore, it is recognized that different regions and cultures have varying perceptions of

42
905 what constitutes ‘aged’. W.H.O. notes that a person may be defined as aged in reference to a number
906 of criteria including chronological age, functional assessment, legislation or cultural considerations to
907 name but a few2.
908 Figure 1

909

910
911
912
913
914
915
916
917
918
919
920 Figure 2
921
922
923
924

2 An added advantage for the IWA is that the removal of the chronological dependency gives a wider
relevance to its recommendations, which now might satisfy a broader set of stakeholder communities.
43
925
926
927
928
929
930
931
932 Figure 3

933
934 The presented viewpoints are illustrated in the Figures below. Figure 4 is a result of synthesizing figures
935 1-3.
936 Figure 1 illustrates the two main ‘people’ concepts, Person and Society, and some of the criteria that are
937 explored in the IWA, providing a context and a basis for understanding the health and care requirements
938 for a single person in a society.
939 Figure 2 focuses on the two main concepts of Person and Society and link them to the third major
940 concept, Quality of Life, which is at the centre of this IWA. Quality of Life establishes the reason for
941 undertaking this IWA. Community is the natural state of a person to be in and to function as part of
942 society, and shows the interdependence of person and society.
943 Figure 3 extends the central concept of Quality of Life considerations, comprising a set of categories
944 where standardization efforts can be meaningfully applied. The categories are social, health, economic,
945 environmental and technological considerations. The last, technological provision, will be a major
946 enabler of services that are both provided and consumed by people to enhance the quality of life,
947 complementing the idea of productive ageing.

44
948 Quality of Life considerations will need to address the requirements for sustainable approaches and also
949 for innovative ones, and necessitate an on-going effort to manage the needs of personal health in an
950 increasingly complex eco-system.
951 The components of the illustration are generic, but all specialized needs and requirements of this IWA
952 are grounded on generic concepts.
953 .
954 Figure 4

955
956
957
958 Contribution from Dr. Nick Guldemond
959
960 Comments and suggestions on IWA draft … circulated separately
961 Key words and phrases
962 community-based co-creation, reciprocity, (profesionals and) agencies, value-based healthcare,
963 shared decision making, interoperability, health = the ability to adapt and to self-manage in the
964 perspective of physical emotional and social challenges
965 Reference Diagrams
966 - Multi-level strategy framework (re interoperability of technology and services)

45
967 - Causes of chronic diseases (re lifestyle diseases)
968 - Disease prevention and control (re Prevention)
969 - Entrepreneurial Innovation : Scientific - Technological - Business Model – Social
970 - Multi-level framework for community-based co-creation of health (re reference architecture)

971
972 - ‘Services improve as a result’ of early engagement of the community people.
973 - ‘Community-based co-creation methodology’ changes systems from a work floor level.
974 - ‘This is to prevent the reinvention of the wheel and stimulate the efficiency of change.’
975 - ‘Benefits of standards’ – reducing the complexity of developing community-based service
976 and business models by a framework, making the model applicable to communities in
977 change.
978
979 Reference Articles
980 - “How should we define health?” (Dr. Huber, BMJ 2011)
981 A challenge to WHO definition of health (1948) : ‘a state of complete … well-being
982 and not merely the absence of disease or infirmity’
983 Change of public health landscape.
984 Proposed definition ‘health’ : the ability to adapt and to self manage…’
985 > (Ref.) WHO ‘Healthy Ageing’ (2015)
986 Healthy Ageing is the process of developing and maintaining the functional ability
987 that enables well-being in older age.
988 - “Towards a new, dynamic concept of health – its operationalisation and use in public health

46
989 and healthcare, and in evaluating health effects of food” (Dr. Machteld Huber, 2014)
990
991
992

993 Bibliography
994
995 “Ageing in Cities” (OECD, Apr., 2015)”
996
997 “World Report on Ageing and Health” (WHO, Oct., 2015)
998

999 Appendix to holistic framework of services

47