Measuring the progress and impact of the UN decade of healthy ageing (2021-2030): framework and indicators recommended by WHO Technical Advisory Group

Measuring the progress and impact of the UN Decade of Healthy Ageing (2021–2030) Framework and indicators recommended by WHO Technical Advisory Group

Measuring the progress and impact of the UN Decade of Healthy Ageing (2021–2030) Framework and indicators recommended by WHO Technical Advisory Group Measuring the progress and impact of the UN Decade of Healthy Ageing (2021–2030) Framework and indicators recommended by WHO Technical Advisory Group Measuring the progress and impact of the UN Decade of Healthy Ageing (2021-2030): framework and indicators recommended by WHO Technical Advisory Group ISBN 978-92-4-010418-1 (electronic version) ISBN 978-92-4-010419-8 (print version) © World Health Organization 2024 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. 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The responsibility for the interpretation and use of the material lies with the reader. In no event shall WHO be liable for damages arising from its use. Editing and design by Inis Communication Contents Acknowledgements iv Abbreviations vi Preface vii Executive summary ix 1. Introduction 1 1.1 Adding years to life and life to years 1 1.2 Technical Advisory Group for Measurement of Healthy Ageing (TAG4MHA) 2 1.3 Scope and purpose of these recommendations 3 1.4 Main audience and intended use 3 2. Unified measurement framework 7 2.1 Measurement framework 7 2.2 The elements of the measurement framework 8 2.3 Principles underpinning monitoring and evaluation of the Decade 9 3. Indicators for tracking progress and impact of the Decade 13 3.1 Measuring progress and impact of UN Decade of Healthy Ageing 13 3.2 Indicators for tracking progress 13 3.3 Healthy ageing indicator meta-data toolkit 18 4. Addressing data and measurement gaps – a way forward 21 4.1 Indicator validation 21 4.2 Evolving understanding of healthy ageing 21 4.3 Advancing the metrics of intrinsic capacity, functional ability and well-being indicators 22 4.4 Closing data and information gaps 25 4.5 Preparation for 2026 and 2029 evaluations of the UN Decade of Healthy Ageing 27 5. Best practices for strengthening monitoring and evaluation systems in countries 31 5.1 Developing a monitoring and evaluation plan 32 5.2 Select a balanced set of indicators 40 5.3 Establish baselines and targets 44 5.4 Strengthening data and information systems 49 5.5 Using M&E findings to guide action 54 5.6. Summary 57 6. References 59 7. Glossary of terms 65 Annexes Annex 1. Proposed implementation activities for each action area in the World Health Assembly document 82 Annex 2. A compendium of indicators across four action areas for region and country selection 86 Annex 3. Monitoring and evaluation plan template 116 iii Acknowledgements This document was developed by Jotheeswaran Amuthavalli Thiyagarajan, Ageing and Health Unit, Department of Maternal, Newborn, Child, Adolescent Health and Ageing (MNCAH), Christopher Mikton, Demographic Change and Healthy Ageing Unit, Department of Social Determinants of Health and Theresa Diaz, Epidemiology, Monitoring and Evaluation Unit, MNCAH, under the direction of Anshu Banerjee, Director, MNCAH, and Etienne Krug, Director, Department of Social Determinants of Health, with valuable input from following World Health Organization (WHO) staff members: Alana Officer, Thiago Herick De Sa and Kazuki Yamada from the Demographic Change and Healthy Ageing Unit, Department of Social Determinants of Health; Matteo Cesari, Yuka Sumi, Hyobum Jang, YeJin Lee and Ritu Sadana from the Ageing and Health Unit, MNCAH; Gerard William Lopez and Moise Muzigaba from the Epidemiology, Monitoring and Evaluation Unit, MNCAH. Kate Loveys from the University of Auckland, New Zealand, consolidated feedback and integrated technical inputs from internal and external technical experts. The following groups and experts reviewed the document and provided technical inputs. UN Steering Committee for Measurement and Monitoring of Healthy Ageing (Karoline Schmid, Chief, Fertility and Population Ageing Section at Population Division, United Nations Department of Economic and Social Affairs; Tapiwa Jhamba, Technical Adviser, United Nations Population Fund; Valentina Stoevska, Senior Statistician, Department of Statistics, International Labour Organization; Daniela Pokorna, Analyst, International Telecommunication Union; Khaled Hassine, Economic, Social & Cultural Rights Advisor, Office of the United Nations High Commissioner for Human Rights; Ana Llena-Nozal, Senior Economist and Paola Sillitti, Research Officer from the Organization for Economic Co-operation and Development; Giampaolo Lanzieri, Senior Expert, Long-term Care and Statistical Methodology, European Commission, Statistical Office of the European Union). WHO Technical Advisory Group For Measurement of Healthy Ageing (TAG4MHA) (Alden Gross, Psychiatric Epidemiologist, Johns Hopkins Bloomberg School of Public Health (JHSPH), United States of America; Andrea Maier, Oon Chiew Seng Professor in Medicine Healthy Ageing and Dementia Research, Co-Director at Centre for Healthy Longevity, National University Health System, National University of Singapore, Singapore; Asghar Zaidi, Vice-Chancellor, Government College University Lahore, Pakistan, and Associate Professorial Fellow, Oxford Institute of Population Ageing, University of Oxford, the United Kingdom of Great Britain and Northern Ireland; Dararatt Anantanasuwong, Associate Dean of School of Development Economics and a Director of Research Center, Senior Researcher and the Director of Center for Aging Society Research at the National Institute of Development Administration, Thailand; Deborah Blacker, Harvard Medical School and Deputy Chair and Professor in the Department of Epidemiology at the Harvard T.H. Chan School of Public Health, United States of America; Hom Nath Chalise, Vice President, Population Association of Nepal, Nepal Treasure, Geriatric Society of Nepal and Faculty Member, Central Department of Population Studies, Kathmandu, Nepal; Hongsoo Kim, Professor of Health Policy and Ageing at the Graduate School of Public Health, Director of the Center for AI Research in Health and Care at the Artificial Intelligence Institute at Seoul National University, Republic of Korea; Jakir H.B. Masud, Chairman of the Public Health Informatics Foundation and Director-Program & Research, Center for Telehealth Services, Bangladesh; Jean Woo, Emeritus Professor of Medicine, Henry G Leong Research Professor of Gerontology and Geriatrics, and Co-Director, Institute of Health Equity, and iv Measuring the progress and impact of the UN Decade of Healthy Ageing (2021–2030) Director, Jockey Club Institute of Aging at The Chinese University of Hong Kong, Hong Kong Special Administrative Region; Katsunori Kondo, Professor, Social Epidemiology and Health Policy, Center for Preventive Medical Science, Chiba University, and President of the Japan Agency for Gerontological Evaluation Study, Japan; Louise Lafortune, Principal Research Associate at Cambridge Public Health, University of Cambridge, and Co-lead Life Course and Ageing Research Pillar, United Kingdom of Great Britain and Northern Ireland; Luigi Ferrucci, Scientific Director, National Institute of Ageing, United States of America; Muthoni Gichu Head of the Division of Geriatric Medicine at the Ministry of Health, Kenya; Prasun Chatterjee, Professor at the Department of Geriatric Medicine in All India Institute of Medical Sciences, India; Rowan Harwood, Professor of Palliative and End of Life Care at the University of Nottingham, and consultant in geriatric and general internal medicine at Nottingham University Hospitals NHS Trust, United Kingdom; Samia A. Abdul-Rahman, Professor of Geriatrics and Gerontology, Faculty of Medicine, Ain Shams University, Egypt; Sebastiana Kalula, Emeritus Associate Professor and Specialist Physician in Medicine and Geriatric Medicine at the University of Cape Town (UCT) and Groote Schuur Hospital in Cape Town, South Africa; Stephen Ojiambo Wandera, Lecturer and Chair of the Department of Population Studies, Makerere University, Kampala, Uganda) and Tina Buffel, Senior Lecturer in Sociology at the University of Manchester, and Director of the Manchester Urban Ageing Research Group (MUARG), United Kingdom of Great Britain and Northern Ireland. The following Colleagues from WHO regional offices provided technical inputs: Samar Elfeky, WHO Regional Office for the Eastern Mediterranean; Mikiko Kanda, WHO Regional Office for the Western Pacific; Patricia Morsch and Enrique Vega, WHO Regional Office for the Americas; Amrita Kansal, WHO Regional Office for South-East Asia; Triphonie Nkurunziza, WHO Regional Office for Africa; and Yongjie Yon, WHO Regional Office for Europe. WHO thanks the WHO Collaborating Centre for Epidemiology of Musculoskeletal Health and Ageing, University of Liege, Belgium; the WHO Collaborating Centre for Longitudinal Studies on Ageing and Life Course, University of Dublin, Ireland and the WHO Collaborating Centre for Healthy Ageing and Dementia, Hamad Medical Corporation, Qatar for support in indicator development. The Public Health Agency Canada, the Ministry of Health, Poland, and the Ministry of Health, Kuwait reviewed the indicators and measurement framework and WHO Global Ageing Population Survey (GAPS) modules of the UN Decade of Healthy Ageing. WHO developed this document with funding from the European Commission’s Ageing Well in the Digital World Programme and Velux Stiftung. vAcknowledgements Abbreviations AFC age-friendly community GAPS Global Ageing Population Survey LMICs low- and middle-income countries M&E monitoring and evaluation ML machine learning NGO nongovernmental organization NSHA national strategy on healthy ageing OCM older citizen monitoring PHAC Public Health Agency of Canada TAG4MHA Technical Advisory Group for Measurement of Healthy Ageing UHC universal health coverage UN United Nations WHO World Health Organization vi Measuring the progress and impact of the UN Decade of Healthy Ageing (2021–2030) Preface Global efforts to foster healthy ageing took a significant leap forward in 2020 when WHO Member States endorsed the Decade of Healthy Ageing (2021–2030) at the Seventy-third World Health Assembly and declared 2021–2030 the UN Decade of Healthy Ageing at the Seventy-fifth United Nations General Assembly. This landmark commitment calls upon the World Health Organization (WHO) to monitor the Decade’s implementation and report on progress through updates in 2023, 2026 and 2029. The success of the Decade depends on the implementation of actions and the establishment of robust national monitoring and evaluation (M&E) systems. A comprehensive measurement framework, with clear indicators, is key to turning data into actionable insights and ensuring that every action taken is measurable and impactful, as well as being aligned with national, regional and global goals. To support this effort, WHO established the Technical Advisory Group for the Measurement of Healthy Ageing (TAG4MHA) in 2022. This group has provided invaluable guidance in developing a comprehensive monitoring framework and a core set of indicators to track the progress and impact of the Decade at all levels. This guidance document also benefited from extensive consultations and feedback from a diverse range of stakeholders. It outlines a clear path for Member States to develop and strengthen their related M&E systems, ensuring they are equipped to monitor progress effectively and drive actionable improvements in healthy ageing initiatives. Recognizing the ongoing challenges that lie ahead – such as resource constraints, and the continuous need to strengthen capacities – a concerted effort is required from all stakeholders. Governments, civil society, the private sector and international organizations must work together, share knowledge, to foster the cross-sectoral collaboration required to overcome these obstacles. Special attention must also be given to ensuring equity, so that no older person is left behind, particularly those from vulnerable and marginalized communities. The task ahead is challenging, but with the commitment and collaboration of all stakeholders, we can ensure that the goals of the United Nations Decade of Healthy Ageing are not only met but surpassed. The time to strengthen our monitoring and evaluation systems is now, so that together we can drive the meaningful progress this is essential to ensuring healthier, longer lives for older people worldwide. Dr Anshu Banerjee Director Maternal, Newborn, Child, Adolescent Health and Ageing World Health Organization Dr Etienne Krug Director Social Determinants of Health World Health Organization viiPreface

Executive summary In 2020, Member States reaffirmed their commitment to fostering healthier and longer lives for older people by endorsing the Decade of Healthy Ageing (2021–2030) at the Seventy-third World Health Assembly and declaring 2021–2030 as the United Nations Decade of Healthy Ageing at the Seventy-fifth United Nations General Assembly. The Decade addresses four interconnected areas of action: (i) to change how we think, feel and act toward age and ageing; (ii) to ensure that communities foster the abilities of older people; (iii) to deliver person-centred integrated care and primary health services that are responsive to older people; and (iv) to provide access to long-term care for older people who need it. The World Health Assembly called upon WHO, in collaboration with other UN agencies, to lead the implementation of the Decade and report to the Secretary-General on progress through triannual reports in 2023, 2026, and 2029. Robust national monitoring and evaluation (M&E) systems are essential for ensuring accountability and accurately assessing progress at national and subnational levels. They provide a critical foundation for tracking achievements, identifying areas for improvement, and validating the impact of policies and actions, thereby fostering transparency and driving meaningful progress. However, a recent process evaluation survey conducted in 2022–2023 across 137 Member States uncovered significant gaps in these systems. Over 40% of Member States lack formal M&E plans, and nearly half do not allocate specific budgets for evaluating national policies, strategies, action plans, or programmes related to healthy ageing. Moreover, the absence of standard indicators, non-comparable data, inconsistent data disaggregation, and limited technical capacity all further hinder the effectiveness of M&E systems. These challenges are compounded by weak integration of M&E findings into policy-making, inadequate stakeholder engagement, and poor coordination across sectors, undermining the effectiveness of M&E systems to track progress in healthy ageing initiatives globally. Mainstreaming healthy ageing M&E frameworks and indicators at national, regional and global levels is a crucial first step in accurately assessing and comparing progress across countries. To support this and address measurement gaps, WHO established the Technical A happy bearded senior man winning a marathon race. ©Freepik ix Advisory Group for the Measurement of Healthy Ageing (TAG4MHA) in 2022. This group provides guidance to WHO on the measurement, monitoring and evaluation of the UN Decade of Healthy Ageing and related programmes. Additionally, to coordinate monitoring and evaluation efforts across agencies, the UN Steering Committee for Monitoring the Decade was formed, comprising representatives from the United Nations Department of Economic and Social Affairs, United Nations Population Fund, International Telecommunication Union, International Labour Organization, Office of the United Nations High Commissioner for Human Rights, Organisation for Economic Co-operation and Development, and the European Commission (Eurostat). This guide outlines the measurement framework and indicators recommended by TAG4MHA to track progress with the Decade progress and related impact at global, regional and national levels. In addition, to support Member States in strengthening national M&E systems, the document also presents best practices and real-world examples from countries reviewing and aligning national strategies for developing robust M&E plans, creating comprehensive measurement frameworks, setting baselines and targets, strengthening data collection and information disaggregation, and effectively disseminating M&E findings to drive actionable improvements. Through a comprehensive review of reports, guidelines and other materials related to the Decade action areas, including the Sustainable Development Goals indicator framework, 22 key measurement domains and over 100 indicators were identified spanning all four action areas of the Decade. Three seniors sitting in a park after a workout. ©Freepik x Measuring the progress and impact of the UN Decade of Healthy Ageing (2021–2030) In consultation with the members of TAG4MHA, 35 core indicators were selected from the indicator compendium, with a focus on those most relevant for monitoring the Decade at all levels and providing actionable insights to inform decision-making and prompt effective action. These core indicators comprise 10 input and process indicators, six output indicators, 16 outcome indicators, and three impact indicators. Accompanying metadata for these indicators – which support validation, adaptation and effective implementation at both national and subnational levels – are available in the online WHO Healthy ageing metadata indicator toolkit (https://platform.who.int/data/maternal-newborn-child-adolescent-ageing/ indicator-toolkit/healthy-ageing-indicators). The core indicators recommended by TAG4MHA were classified into three tiers: Tier I (n=13) includes indicators that are conceptually clear, have an internationally established methodology and standards, and are regularly produced by at least 50% of countries and relevant populations; Tier II (n=5) consists of indicators that are conceptually clear and have an internationally established methodology and standards, but related data are not regularly produced by countries; and Tier III (n=17) comprises indicators that currently lack an internationally established methodology or standards, although these are in the process of being developed or tested. For thirteen core indicators, data are collected at the national level, while the rest require data collection at the population level using survey method. With the support of the TAG4MHA, WHO is committed to addressing the critical measurement and data gaps essential for strengthening the monitoring and evaluation of the Decade at global, regional and national levels. This commitment includes validating Tier III indicators in collaboration with Member States, refining the concepts of healthy ageing by operationalizing functional ability, intrinsic capacity and well-being, and enhancing the methodology for constructing composite score for multidimensional indicators recommended in this guide. Additionally, WHO aims to close existing data gaps by expanding the Global Ageing Population Survey (GAPS), particularly in low and middle-income countries. These efforts are crucial for ensuring comprehensive, accurate and comparable data are available to assess the progress toward the goals of the Decade. The primary audience for this document includes stakeholders involved in collecting, interpreting and using data related to older people. Consistent use of this guidance will ensure better focus and alignment of healthy ageing data collection efforts, helping countries and regional and global stakeholders to uniformly collect, compile, report and use critical information to guide improvements. This document will be periodically updated as additional resources and insights emerge. The indicators and measurement approaches featured in this guide are being tested in different countries. Moving forward, WHO aims to provide regular updates on the indicators and metadata via its Healthy ageing online indicator portal (https://platform.who.int/data/ maternal-newborn-child-adolescent-ageing/ageing-data), which serves as a valuable resource for stakeholders tracking and evaluating progress towards the UN Decade of Healthy Ageing (2021–2030). xiExecutive summary A senior man stretching his legs. ©Freepik Introduction 1 1. Introduction 1.1 Adding years to life and life to years Over the past century, all nations have undergone a demographic revolution marked by a significant increase in the life expectancy of older persons aged 60 years and over (1). Recent demographic estimates reveal a compelling trend: the global population of people aged 60 years and over is expanding rapidly (2). By 2050, the number of people in this age group is projected to double from approximately 1.1 billion in 2023 to 2.1 billion, constituting 22% of the world’s population, with more than 80% living in low- and middle-income countries (LMICs). Since the start of the 21st century, most parts of the world saw a steady increase in the life and health spans of older adults, but the COVID-19 pandemic reversed this progress, wiping out nearly two decades of gains in just two years. Life expectancy at age 60 dropped by 1.4 years to 19.6 years in 2021 (reverting to 2006 levels). In parallel, healthy life expectancy at age 60 dropped to 14.7 years in 2021 (also reverting to 2006 levels) (3). In 2020, amid the COVID-19 pandemic, Member States reaffirmed their commitment to fostering healthier and longer lives for older people by endorsing the United Nations (UN) Decade of Healthy Ageing (2021–2030) at the Seventy-third World Health Assembly and its subsequent adoption by the Seventy-fifth United Nations General Assembly (4). The UN Decade of Healthy Ageing is a global collaboration, aligned with the final ten years of the Sustainable Development Goals (SDG), that brings together governments, civil society, international agencies, professionals, academia, the media, and the private sector to improve the lives of older people, their families and the communities in which they live. The Decade outlines four action areas and key enablers (Box 1) that provide strategic guidance for the Member States and other stakeholders (5). Despite the pandemic, several countries have made significant progress in implementing national strategies, action plans or programmes to support the implementation of all four action areas of the Decade. According to the corresponding process evaluation survey (6), approximately 81% of participating countries (i.e. 108 of 133 countries) have implemented a national action plan on ageing. However, there are notable gaps in monitoring and evaluation (M&E) efforts. More than 40% of these nations lack an M&E plan for their national strategy and action plan on ageing, and almost half do not have a specific budget allocated for supporting the implementation and M&E efforts (7). Going forward, supporting countries to build a strong national, regional and global M&E systems is crucial for generating the high-quality, consistent data necessary for meaningful regional and global assessments of the progress and impact of the Decade. These mechanisms are key to promoting transparency, accountability, learning, evidence-based decision-making, effective resource allocation, and stakeholder engagement (8,9). However, the effectiveness of M&E systems hinges on several factors, including political will, financial resources and available technical capacity. Governments must demonstrate a commitment to supporting M&E efforts by providing adequate resources, institutional support and technical assistance to effectively implement M&E systems. Framework 2 Indicators 3 Gaps 4 Best practices 5 References Glossary 6 7 11. Introduction Introduction1 Box 1. UN Decade of Healthy Ageing (2021–2030) Healthy ageing is defined as: “…the process of developing and maintaining the functional ability that enables well-being in older age.” Functional ability comprises the health-related attributes that enable people to be and to do what they have reason to value. It is made up of the intrinsic capacity of the individual, relevant environmental characteristics and the interactions between the individual and these characteristics. These include ability to: meet basic needs, learn, grow and make decisions, be mobile, build and maintain social relationships and contribute. Intrinsic capacity is the composite of all the physical and mental capacities of an individual. These include, cognitive capacity, psychological capacity, sensory capacity, vitality capacity and locomotor capacity. The four action areas of the Decade are: • to change how we think, feel and act toward age and ageing; • to ensure that communities foster the abilities of older people; • to deliver person-centred, integrated care and primary health services that are responsive to older people; and • to provide access to long-term care for older people who need it. The four enablers of the Decade are: • listening to diverse voices and enabling meaningful engagement of older people, family members, caregivers, young people and communities; • nurturing leadership and building capacity to take appropriate action integrated across sectors; • connecting various stakeholders around the world to share and learn from the experience of others; and • strengthening data, research and innovation to accelerate implementation. 1.2 Technical Advisory Group for Measurement of Healthy Ageing (TAG4MHA) To advance the measurement activities, WHO established a Technical Advisory Group for the Measurement of Healthy Ageing (TAG4MHA) in 2022, to provide advice on the measurement, monitoring and evaluation of the Decade and programmes related to the action areas (10). The TAG4MHA, in association with the UN Steering Committee, was established to align with existing measurement advisory groups, including those overseeing maternal, child and adolescent health (11–13). Together, these groups aim to strengthen data and measurement for monitoring health and associated conditions across the life course, and to ensure progress on accountable action. The TAG4MHA comprises 20 experts selected through an open nomination and selection process. Members were selected based on their technical expertise in relevant areas, such as epidemiology, geriatrics, social gerontology, economics, demography, community development, health policy, psychometrics and statistics, as well as relevant expertise Framework2 Indicators3 Gaps4 Best practices5 References Glossary 6 7 2 Measuring the progress and impact of the UN Decade of Healthy Ageing (2021–2030) Introduction 1concerning international public health programme evaluation (e.g. programme M&E, information systems related to diverse sectors pertinent to the Decade and population surveys/censuses and digital health). TAG4MHA objectives 1. To provide technical guidance to the World Health Organization (WHO) and other UN agencies on the framework and indicators for tracking progress and evaluating the impact of the UN Decade of Healthy Ageing at all levels (i.e. global, regional, national and subnational). 2. To support the standardization of measures, modes of data collection, data harmonization for comparability and data analysis across all indicators for the UN Decade of Healthy Ageing, and guidance for decision making and capacity building in these areas at the country level. 3. To provide guidance on measurement and operationalization of new and existing indicators linked to actions areas of the UN Decade of Healthy Ageing and related programmes or initiatives. 4. To propose methods for producing global, regional, national and subnational estimates linked to the UN Decade of Healthy Ageing. The TAG4MHA has built a global partnership with over 40 academic institutions and collaborates with international national agencies, including the UN Department of Economic and Social Affairs, UN Population Fund, International Telecommunications Union, International Labour Organization, UN Women, the Office of the United Nations High Commissioner for Human Rights, the Organisation for Economic Co-operation and Development, and the Statistical Office of the European Commission. Additional information is available on the TAG4MHA website (https://www.who.int/groups/technical-advisory-group- for-measurement-monitoring-and-evaluation-of-the-un-decade-of-healthy-ageing) (10). 1.3 Scope and purpose of these recommendations This document presents a unified measurement framework and describes a list of core indicators recommended for monitoring the UN Decade of Healthy Ageing. The indicators presented are relevant for all countries implementing national policies, action plans or strategies to improve older persons’ well-being and healthy lives in support of the Decade. In addition to the measurement framework, the document uses country examples to offer best practice recommendation for strengthening national monitoring and evaluation systems. For the purposes of monitoring activities, older people are defined as aged 60 years and over. 1.4 Main audience and intended use The primary target audiences for this document include: • Monitoring and evaluation (M&E) officers and coordinators. Professionals tasked with designing, implementing and managing evaluation systems related to healthy ageing. • National focal points for ageing and healthy ageing programmes. Individuals designated to oversee ageing and healthy ageing initiatives within government agencies or departments. Framework 2 Indicators 3 Gaps 4 Best practices 5 References Glossary 6 7 31. Introduction Introduction1 The document may also benefit: • National and subnational policy-makers and leaders in healthy ageing. Those responsible for shaping, implementing and translating policies and strategies into action related to healthy ageing at both national and subnational levels. • National statistics offices and ministries of health. These are entities responsible for collating, collecting, analysing and disseminating data on health and ageing trends within a country. • International partners and nongovernmental organizations (NGOs). Organizations collaborating with governments to support healthy ageing initiatives, including through funding, technical assistance, advocacy, data collection, and the organization of health and other services. • Civil society. Organizations and groups representing the interests of older people and advocating for their rights and well-being. • Partners supporting national and subnational efforts. Entities providing support, resources and expertise to national and subnational efforts to measure and monitor healthy ageing action plans and strategies. • Health programme managers. Professionals managing specific health programmes focused on long-term and integrated care for older people. • M&E professionals from related sectors. Professionals involved in monitoring and evaluating programmes and policies in sectors related to ageing, such as education, labour, social affairs, transportation, housing, urban planning, information and communication, and public health research, within academic or other research institutions. To develop a comprehensive measurement framework and identify all potential indicators, WHO conducted a thorough review of various guidelines, reports and documents related to the action areas of the UN Decade of Healthy Ageing (4,5). These sources included the Global report on ageism (14), the World report on ageing and health (15), the Decade of Healthy Ageing: baseline report (16), Measuring the age-friendliness of cities: a guide to using core indicators (17), Long-term care for older people: package for universal health coverage (18), National programmes for age-friendly cities and communities: a guide (19), Integrated care for older people (ICOPE): guidance for person-centred assessment and pathways in primary care (20), Global strategy and action plan on ageing and health (21), Global indicator framework for the Sustainable Development Goals (22) and the Madrid international plan of action on ageing (23). Following this review, potential domains and indicators for measurement were shortlisted for further consultation with the TAG4MHA. The measurement framework and indicators recommended in this document were presented to representatives from WHO Member States for feedback during several key events in 2023– 2024. These included, a regional summit on policy innovation for healthy ageing in Lisbon, Portugal; regional meeting on healthy ageing in New Delhi, India; and the WHO Symposium on Monitoring and Evaluation of the UN Decade of Healthy Ageing, organized by the WHO Collaborating Centre for Healthy Ageing and Dementia with representatives from Member States of the WHO Eastern Mediterranean Region. Additionally, dedicated meetings were held by the Public Health Agency of Canada and the Ministry of Health of Poland, involving various government departments engaged in monitoring national and subnational action plans and programmes on healthy ageing. These meetings provided a platform to review and refine the measurement framework and indicators. Formal consultations with Member Framework2 Indicators3 Gaps4 Best practices5 References Glossary 6 7 4 Measuring the progress and impact of the UN Decade of Healthy Ageing (2021–2030) Introduction 1States will take place in 2025–2026, following the validation of the indicators and metadata presented in this document. This process will ensure that the final framework and indicators are thoroughly reviewed and endorsed by all relevant stakeholders. The current iteration of the document will be subject to periodic updates as additional resources become available. The document features an extensive range of indicators and measurement approaches currently undergoing field testing in various countries. Moving forward, WHO aims to provide regular updates on the indicators and metadata via the Healthy ageing online indicator portal (see: https://platform.who.int/data/maternal-newborn-child- adolescent-ageing/indicator-toolkit/healthy-ageing-indicators), which provides a valuable resource for stakeholders seeking to track and evaluate progress towards the UN Decade of Healthy Ageing (2021–2030). An elderly couple in the countryside. ©Freepik Framework 2 Indicators 3 Gaps 4 Best practices 5 References Glossary 6 7 51. Introduction Two smiling African women dressed in colorful clothing. ©Freepik Framework 22. Unified measurement framework 2.1 Measurement framework An effective monitoring and evaluation (M&E) framework serves as the backbone for systematic, routine data collection and analysis, guiding impactful evaluation activities. The Decade M&E framework (Fig. 1) is designed to measure, monitor and evaluate the progress and impact of action areas across global, regional, national and subnational levels. The framework integrates oversight (monitoring) with the assessment of choices, processes, decisions, actions and results (evaluation) and is anchored on the WHO public health framework for healthy ageing (12, 21). It serves two main purposes: • At the national and subnational levels, it assists stakeholders in tracking progress, assessing the impact of public actions outlined in each country’s strategy, and planning or programming for healthy ageing. Additionally, if data is collected using this unified framework, learning from experiences can be facilitated to enhance policy and programme implementation. • Externally, it promotes transparency and accountability by enabling countries to share information on successes and failures with all stakeholders. The framework is organized with the long-term anticipated impact positioned at the far right of the schematic diagram (Fig. 1). Progressing towards this impact, short-, medium- and long-term outcomes are arranged sequentially, with outputs from the implementation of actions serving as preconditions for achieving these outcomes. Inputs – foundational resources and conditions required to initiate and sustain activities that lead to the desired outcomes, are described on the left of the schematic. In this way, the framework spans 22 key domains across all four action areas of the Decade, ranging from political commitment and intergenerational initiatives to social protection and well-being. Introduction 1 Indicators 3 Gaps 4 Best practices 5 References Glossary 6 7 72. Unified measurement framework Framework2 2.2 The elements of the measurement framework The main components of the framework are outline below. Vision: A world where all older people can live long and healthy lives. Goal: To improve the lives of older people, their families and their communities. Objectives of action: Specific objectives of the four UN Decade action areas (see Box 1) that contribute to the identified population outcomes: • By 2030, decrease the proportion of older people who experience stereotypes, prejudice and discrimination based on age. • By 2030, increase the proportion of older people living in cities, towns and rural areas that are working to become age-friendly. • By 2030, increase the coverage of integrated health and social care services as part of universal health coverage (UHC) to maximize intrinsic capacity and functional ability. • By 2030, increase the coverage of long-term care services as part of UHC to meet older people’s and carers’ health and social care needs, to ensure autonomy, independence and dignity. Inputs and processes: Measures political commitment and leadership, policies and legislation, voice and engagement, resources and financial protection, workforce and training, and data and information systems that enable the implementation and achieve the objectives of the action areas. Outputs: Describe the results of the activities undertaken to improve outcomes. This includes fostering age-friendly communities, accessibility, availability, affordability and intergenerational initiatives. The Member States’ specific actions (i.e. tasks and processes) that contribute to the identified outputs and outcomes (see Annex 1). Outcomes: Measures whether the implemented actions are effectively achieving the expected short- and medium-term outcomes, such as reducing ageism, enhancing age-friendly communities, improving the quality and coverage of care services, expanding coverage of health and long- term care services, reducing risk factors, and boosting intrinsic capacity, functional ability. Impacts: Measures the ultimate objective that the Decade is expected to affect. The ultimate objective of the Decade is to positively impact key measures such as long and healthy lives, as well as enhancing well-being. Introduction1 Indicators3 Gaps4 Best practices5 References Glossary 6 7 8 Measuring the progress and impact of the UN Decade of Healthy Ageing (2021–2030) Framework 2 The M&E framework is founded on the assumption that Member States implement all four of the Decade’s proposed actions and related activities (Annex 1). It also assumes that the impact of unintended external factors – such as political changes, economic conditions, natural disasters, security issues, health emergencies, and continuity of funding – can be minimized. 2.3 Principles underpinning monitoring and evaluation of the Decade The six key principles underpinning global monitoring of the Decade are: Global systems perspective. Healthy ageing should be a universal goal, requiring a global systems perspective in its evaluation (12). These efforts should consider how demographic trends, policies, economic disparities and environmental factors influence older populations. Given the complex interplay of health care, social determinants, lifestyle choices and resources, evaluations should be holistic and account for these interconnected systems (13,24). Stakeholder engagement. Throughout the monitoring and evaluation cycle of the Decade, engagement with stakeholders is crucial because it ensures that the diverse needs and perspectives of older people and other relevant groups are considered while also promoting inclusivity, accountability, sustainability, effectiveness and collaborative progress (25). Human rights. Integrating human rights principles guarantees that older people’s rights – such as access to health care, social protection and freedom from discrimination – are upheld and monitored (26). This principle guarantees that the monitoring and evaluation system tracks progress, safeguards the well-being of older people, and promotes their full inclusion and participation in all related efforts (27,28). Measuring what matters. The selection of indicators for monitoring healthy ageing action plans should be driven by their relevance and effectiveness in capturing desired outcomes, rather than the mere availability of data (29). Indicators should be chosen based on their potential to offer meaningful insights and guide decision-making. Data collection efforts should be designed to support these indicators, rather than restricting the selection to those that are simply easy to measure (30,31). Transparency and accountability. These are fundamental principles in monitoring healthy aging because they ensure that actions and progress are visible and verifiable to all stakeholders, including policy-makers, care providers and the public (32). Transparency in reporting and sharing of data allows for a clear understanding of what is being achieved and where improvements are needed. It builds trust among stakeholders, as everyone can see the evidence of efforts and outcomes. Accountability, on the other hand, ensures that organizations and governments are held responsible for their commitments to improve the health and well-being of older populations (29). Equity and social justice. Disparities in population outcomes related to healthy ageing are influenced by age and sex, as well as factors that shape peoples’ opportunities for access to power and resources, such as income, education, race, ethnicity, gender, and geography (24,33). Evaluation results should be appropriately disaggregated by these characteristics to assess which groups may be being left behind in public actions, and to document progress towards improving health equity (24). Introduction 1 Indicators 3 Gaps 4 Best practices 5 References Glossary 6 7 92. Unified measurement framework Fig. 1. UN Decade of Healthy Ageing monitoring and evaluation framework Note: Process indicators are not explicitly listed separately in the framework for the UN Decade of Healthy Ageing because they are highly dependent on the specific activities and initiatives undertaken by each country Change how we think, feel and act towards age and ageing Ensure that communities foster the abilities of older people Deliver person-centred integrated care and primary health services responsive to older people Provide access to long-term care for older people who need it Input Data sources Impact Process evaluation survey Insurance claim data Health care administrative data WHO Global campaign to combat ageism National health workforce data WHO global network for age-friendly cities and communities Population- based surveys 1. Political commitment and leadership 2. Policy and legislation 3. Voice and engagement 6. Data and Information systems 9. A‚ordability of services 14. Age-friendly environment 11. Inter- generational initiatives 12. Quality of health and long-term care services 21. Long and healthy lives 22. Well-being 8. Accessibility of services 7. Availability of services 13. Coverage of health and long-term care services 18. Intrinsic capacity 19. Functional ability 20. Care dependence 17. Ageism 4. Financial resources 5. Workforce and training 15. Risk factors 10. Fostering age-friendly communities 16. Social protection Output Outcome 10 Measuring the progress and impact of the UN Decade of Healthy Ageing (2021–2030) A senior man playing chess at the park. ©Unsplash A South-East Asian woman carrying items along a rural road. ©Unsplash Indicators 3 3. Indicators for tracking progress and impact of the Decade 3.1 Measuring progress and impact of UN Decade of Healthy Ageing Monitoring the progress and impact of the Decade is crucial for ensuring accountability and empowering Member States to accelerate public actions towards achieving the objectives of the action areas. By integrating process, outcome and impact evaluations, WHO effectively tracks the Decade at various time periods (i.e. 2023, 2026 and 2029) and levels (i.e. national, regional and global). WHO conducts three types of evaluations, focusing on assessment of process, outcome and impact. Process evaluations assess the extent to which the critical enablers of the Decade are implemented as planned. Outcome evaluations measure the immediate benefits and effectiveness of public actions. Impact evaluations gauge long-term changes and sustainability. In this way, evaluations provide a comprehensive view of the Decade’s progress and impact, offering essential guidance to Member States for improving and shaping future policy and programme decisions. 3.2 Indicators for tracking progress To comprehensively identify potential indicators, WHO conducted a thorough review of various guidelines, reports and documents related to the action areas of the Decade. These sources (4,5,14–23). Following this review, WHO shortlisted over 100 indicators for further consultation with the TAG4MHA (see Annex 2). The process of identifying a core set of indicators was conducted in two phases. The first phase involved an internal review and discussions within WHO, with input from technical leads responsible for each action area of the Decade. The second phase consisted of consultation meetings with experts from the TAG4MHA to refine and select core indicators. Utilizing the measurement framework (see Fig. 1) and potential indicators (Annex 2), TAG4MHA recommended 35 core indicators for monitoring the progress and impact of the Decade, as outlined in Table 1. These indicators were selected based on two key criteria: relevance and actionability. The core set includes 10 input and process indicators, six output indicators, 16 outcome indicators, and three impact indicators. For 13 core indicators, data are collected at the national level, while the rest require data collection at the population level using survey methods. The core indicators recommended by TAG4MHA were classified into three tiers: Tier I (n=13) includes indicators that are conceptually clear, have an internationally established methodology and standards, and are regularly produced by at least 50% of countries and relevant populations; Tier II (n=5) consists of indicators that are conceptually clear and have an internationally established methodology and standards, but data are not regularly produced by countries; and Tier III (n=17) comprises indicators that currently lack an internationally established methodology or standards, though these are in the process of being developed or tested. Introduction 1 Framework 2 Gaps 4 Best practices 5 References Glossary 6 7 133. Indicators for tracking progressand impact of the Decade Table 1. Overview of recommended core indicators for measuring progress and impact Domain Indicators Indicator type Data collection level Tier 1. Political commitment and leadership 1.1 Percentage of countries with a national focal point for ageing and health in the ministry of health or equivalent Input/Process National I 2. Policy and legislation 2.1 Percentage of countries with current national policy, action plan, strategy or programme on ageing and health Input/Process National I 2.2 Percentage of countries with current national legislation and enforcement strategies against age-based discrimination Input/Process National I 2.3 Percentage of countries with current national legislation, policies, strategies, frameworks, plans or programmes that include age-friendly environments Input/Process National I 2.4 Percentage of countries with current national strategy, action plan, programme, policy and/or legislation that includes (incentives and resources) comprehensive assessments of the health and social care needs of older people Input/Process National I 2.5 Percentage of countries with current legislation or regulation that provides older persons with access to assistive products from the WHO Priority assistive products list (34) Input/Process National I 2.6 Percentage of countries with current national strategy, action plan, programme, policy and legislation to support the implementation of long-term care for older persons Input/Process National I 3. Voice and engagement 3.1 Percentage of countries with national multi- stakeholder forum or committee on ageing and health Input/Process National I 14 Measuring the progress and impact of the UN Decade of Healthy Ageing (2021–2030) Domain Indicators Indicator type Data collection level Tier 6. Data and information systems 6.2 Percentage of countries with any cross- sectional survey(s) on healthy ageing with a nationally representative sample of older people Input/Process National I 6.3 Percentage of countries with a longitudinal survey(s) on healthy ageing with a nationally representative sample of older people Input/Process National I 7. Availability of services 7.1 Percentage of primary care or any other health facilities offering care services defined in the WHO ICOPE UHC packages of care services Output National III 8. Accessibility of services 8.3 Percentage of older people who have forgone care due to cost, distance or sociocultural factors, over the past year Output Population III 10. Fostering age- friendly cities and communities 10.2 Percentage of cities, towns or rural areas working to become age-friendly communities that have completed a baseline assessment over the past year Output National III 10.3 Percentage of cities, towns or rural areas working to become age-friendly communities that have developed a strategy and action plan over the past year Output National III 10.4 Percentage of cities, towns or rural areas working to become age-friendly communities that have completed an evaluation over the past year Output National III 11. Intergenerational initiative 11.1 Percentage of older people engaged in intergenerational initiatives over the past year Output Population III 153. Indicators for tracking progressand impact of the Decade Domain Indicators Indicator type Data collection level Tier 12. Quality of health and long-term care services 12.1 Percentage of older people who have received cataract surgery and have a resultant good quality outcome (6/12 or better) relative to the number of people in need of cataract surgery over the past year Outcome Population II 12.7 Percentage of older people who received surgical treatment for hip fractures within 48 hours after admission to the hospital, over the past year Outcome Population II 12.6 Percentage of older people who report age-based discrimination in health or long- term care services, over the past year Outcome Population III 13. Coverage of health and long-term care services 13.4 Percentage of older people with declines in mobility or locomotor capacity who received rehabilitation services over the past year Outcome Population III 13.7 Percentage of older people in need of hearing aids who received hearing aid services over the past year Outcome Population III 13.8 Percentage of older people diagnosed with depression who received psychosocial, pharmacological, rehabilitation and/ or aftercare services over the past year Outcome Population III 13.12 Percentage of informal caregivers (of older people in need of support) who received caregiving training over the past year Outcome Population III 13.13 Percentage of older people in need of long-term care services receiving long- term care at facilities or in their home in the community over the past year Outcome Population II 14. Age-friendly environment 14.24 Percentage of older people who believe decision-making is inclusive and responsive over the past year Outcome Population II 14.25 Percentage of older people living in age- friendly cities, towns or rural areas over the past year Outcome National II 15. Risk factors 15.2 Percentage of older people who report insufficient physical activity, over the past year Outcome Population I 16 Measuring the progress and impact of the UN Decade of Healthy Ageing (2021–2030) Domain Indicators Indicator type Data collection level Tier 17. Ageism 17.1 Percentage of older people who report that others do not value their contribution, others may feel frustrated by them because of their age, and/or others make decisions for them because of their age (interpersonal ageism) over the past year Outcome Population III 17.2 Percentage of older people limiting participation in discussion about things that affect them (self-directed ageism) over the past year Outcome Population III 17.3 Percentage of older people who report that policies made by the government do not meet their needs, due to discrimination on age nested in the policy (institutional ageism) over the past year Outcome Population III 18. Intrinsic capacity 18.1 Percentage of older people with higher intrinsic capacity, over the past year Outcome Population III 19. Functional ability 18.2 Percentage of older people with higher functional ability, over the past year Outcome Population III 21. Long and healthy lives 21.1 Life expectancy at age 60, over the past year Impact Population I 21.2 Healthy life expectancy at age 60, over the past year Impact Population I 22. Well-being 22.1 Percentage of older people with higher well-being (subjective), over the past year Impact Population III 173. Indicators for tracking progressand impact of the Decade Indicators3 3.3 Healthy ageing indicator meta-data toolkit Metadata for each indicator provide the technical information needed to understand that indicator. The metadata have been developed to support alignment in data collection and use of the indicators. Fig. 2 provides an overview of the structure used to organize the metadata in the indicator tables and explains the different elements. The metadata for the core tier I and II indicators recommended by TAG4MHA are available in the WHO Healthy ageing indicator metadata toolkit (35). The platform provides a detailed overview of recommended indicators for monitoring the UN Decade of Healthy Ageing (2021–2030). It includes a searchable database where users can find metadata for each indicator, including definition, preferred data sources, method of measurement, and limitations of the indicators. The platform will be updated annually as more information on indicator validation studies become available and it will continue to offer more detailed information on various indicators, data visualizations, and reports to support policy-makers, researchers and advocates in tracking progress and addressing healthy ageing challenges. The toolkit also provides links to data access for validated indicators to support countries and regions. A Vietnamese senior woman making Tet cake for the lunar new year. ©Freepik Introduction1 Framework2 Gaps4 Best practices5 References Glossary 6 7 18 Measuring the progress and impact of the UN Decade of Healthy Ageing (2021–2030) Indicators 3 Fig. 2. Overview of indicator metadata I. Indicators that are conceptually clear, have an internationally established methodology and standards, and are regularly produced by at least 50% of countries and relevant populations Indicator name Indicator short name Definition Numerator Denominator Justification Data collection level Preferred data source Other possible data source(s) Method of measurement Disaggregation Limitation Definition of the concept that being measures The upper portion (numerator) and lower portion (denominator) of a fraction. For some indicators (such as life expectancy at age 60), only a numerator is specified. Justification for why this indicator is important and recommended Age (five-year age band), sex, income level, education level, place of residence (administrative region, e.g. cities, towns, semi-dense areas, and rural areas), setting (residential care facility, at home in the community), disability status, nationally relevant population groups An overview of estimation and methodological points about how the indicator is measured Most of the indicators are based on data collected at national level or at the population level. Preferred data source include: • WHO Process Evaluation Survey • Population Surveys • Health care administrative data • WHO Global Network for Age-Friendly Cities and Communities Key limitations of the indicator including challenges with data comparability due to di’erences in how data is collected and reported across di’erent settings Domain title II. Indicators that are conceptually clear and have an internationally established methodology and standards, but data are not regularly produced by countries III. Indicators that currently lack an internationally established methodology or standards, though these are in the process of being developed or tested Indicator (short name) Description Rationale Measurement Remark Tier I Tier II Tier III Introduction 1 Framework 2 Gaps 4 Best practices 5 References Glossary 6 7 193. Indicators for tracking progressand impact of the Decade A smiling Burkinabe woman standing outdoors. ©Freepik Gaps 4 4. Addressing data and measurement gaps – a way forward 4.1 Indicator validation Validity, reliability and responsiveness of an indicator are critical to ensuring that data collected accurately reflect the true state of the issue being measured, can be consistently reproduced across different settings and times, and can detect meaningful changes over time. This ensures that monitoring and evaluation efforts are both effective and actionable, leading to informed decision-making and effective interventions. The seventeen Tier III indicators recommended in this guidance require statistical validation studies in countries (see Table 1). Future empirical studies should test the construct validity (including content, structural, convergent and discriminant validity), criterion validity (such as concurrent, content, construct, and predictive validity), reliability (test-retest reliability), and responsiveness (sensitivity to detect change) of indicators. More information on recommended approaches to testing the various measurement properties of indicators are available (36). 4.2 Evolving understanding of healthy ageing Intrinsic capacity and functional ability are two pivotal outcome indicators recommended in this guide to measure healthy ageing of the population. These two indicators are multidimensional in nature, making it inappropriate to capture with a single measure. Intrinsic capacity combines an individual’s physical and mental capacities, whereas functional ability relates to the capabilities that enable older people to be and to do what they value (15,37). Functional ability manifests because of interaction between a person’s intrinsic capacity and their environments (38). It includes the abilities to meet basic needs, learn, grow, make decisions, stay mobile, build and maintain relationships, and contribute to society. Although these constructs are defined by a set of sub-domains (see Box 1), there is potential to explore additional attributes as sub-constructs. For instance, incorporating cardiovascular capacity into the measurement framework of intrinsic capacity, or including the ability to perform basic activities of daily living within the functional ability construct, could enhance the specificity and relevance of these indicators. Furthermore, the sub-domains of intrinsic capacity and functional ability require operational definitions that account for the availability of data to accurately capture the intended aspects of healthy ageing. It is important to recognize that different populations may interpret or experience intrinsic capacity and functional ability differently due to cultural, social and other environmental factors. As the understanding of healthy ageing advances with emerging evidence, the definitions and measurements of related concepts must also evolve. Regular clarification and refinement of these constructs are essential to ensuring that measurement tools remain both relevant and accurate, reflecting the most current scientific evidence (36). Introduction 1 Framework 2 Indicators 3 Best practices 5 References Glossary 6 7 214. Addressing data and measurement gaps – a way forward Gaps4 4.3 Advancing the metrics of intrinsic capacity, functional ability and well-being indicators Three outcome indicators recommended in this toolkit (intrinsic capacity, functional ability and well-being) are multidimensional in nature. For instance, intrinsic capacity is a composite of locomotor capacity, sensory capacity, cognitive capacity, psychological capacity vitality capacity (39). Functional ability includes the capacity to meet basic needs, learn, grow, make decisions, stay mobile, build and maintain relationships, and contribute to society. Well-being measures are closely related to both intrinsic capacity and functional ability. Intrinsic capacity provides the foundation for an individual’s potential, while functional ability reflects the practical application of that potential in ability to do things valuable to older persons. Well-being integrates these aspects by capturing how they influence overall life satisfaction and quality of life (41). There is a need for empirical studies to understand the overlap between well-being, intrinsic capacity and functional ability to avoid collinearity in healthy ageing metrics. In addition, measurement of intrinsic capacity and functional ability indicators requires a combination of different types of measures to generate composite scores. There are range of methods that can be used to construct a composite score. These include simple summation, averaging, weighted summation, principal component analysis, factor analysis, item response theory, composite Z-scores, machine learning, index method and Bayesian approaches (42). The choice of method depends on the nature of the data, the goals of the analysis, and the available expertise (43). Simple methods like summation or averaging are easier to implement but may lack nuance, while more sophisticated methods, such as principal component analysis, factor analysis, machine learning or Bayesian approaches, can provide more accurate and meaningful composite scores but require more complex modelling (44,45). Empirical analysis is needed to determine the best composite scoring method for capturing underlying constructs. The chosen scoring method should be tested on a small scale or pilot dataset to assess its construct validity, predictive validity, accuracy and sensitivity to detect change over time. Balancing the complexity of the method with the need for valid, reliable and interpretable results is important when choosing the appropriate method for creating a composite score for indicators. Box 2 presents an example method for developing composite scores using factor analysis for intrinsic capacity, for use as part of cross-country comparisons. Introduction1 Framework2 Indicators3 Best practices5 References Glossary 6 7 22 Measuring the progress and impact of the UN Decade of Healthy Ageing (2021–2030) Gaps 4 Box 2: Using factor analysis to construct composite score for intrinsic capacity and sub-domains A recent analysis, WHO and collaboration with academic partners test one of the statistical approach to construct a composite score for intrinsic capacity and its five sub-domains (psychological, locomotor, cognitive, vitality and sensory capacities) for older persons living in England and China, but born during the same time period (46). The first step in constructing the composite score was to identify relevant variables that contributed to intrinsic capacity. These variables were selected from two large, longitudinal datasets: the English Longitudinal Study on Ageing (ELSA) and the China Health and Retirement Longitudinal Study (CHARLS). Fig 3. Trajectories of intrinsic capacity of older persons in England and China born during the same period Panel A. England Panel B. China Introduction 1 Framework 2 Indicators 3 Best practices 5 References Glossary 6 7 234. Addressing data and measurement gaps – a way forward Gaps4 To analyse changes in intrinsic capacity across time and populations, the study used a measurement invariance testing approach to ensure the constructs (intrinsic capacity and its subdomains) were measured equivalently across waves. First, confirmatory factor analysis (CFA) assessed whether the same factor structure held over time (configural invariance). If configural invariance was confirmed, scalar invariance was tested to ensure that factor loadings and intercepts were consistent, allowing valid comparisons of intrinsic capacity levels across time. Weighted least squares mean and variance adjusted (WLSMV) estimation was applied with pairwise deletion to maximize the use of available data, generating factor scores for intrinsic capacity and subdomains. Multilevel growth curve models were then employed to model changes in intrinsic capacity and its subdomains over time, accounting for both linear and quadratic trajectories (for ELSA) and cohort differences through interaction terms with birth year. Random effects were used to capture individual differences in baseline levels and rates of change. Survey weights ensured that the results were representative of the populations in both studies, and longitudinal weights in ELSA accounted for non-response across waves. Constructing composite score for intrinsic capacity: A composite score is used to summarize multiple individual measures into a single index, providing a more comprehensive assessment of a complex construct. The composite score in this study integrated various indicators across physical, cognitive, sensory, psychological, and vitality domains, reflecting the multidimensional nature of intrinsic capacity. The bifactor CFA models was used to construct a general composite score for intrinsic capacity. In bifactor models, all observed variables load onto a general factor (intrinsic capacity) while also loading onto specific subdomain factors (e.g., cognitive, locomotor, sensory). The general factor captured the overall intrinsic capacity, while the subdomain-specific factors explained the unique variance within each domain. This modelling approach allowed for the separation of the overall capacity from domain-specific nuances. To ensure that the composite scores accurately represented the broader populations from which the data were drawn, the researchers applied survey weights. In ELSA, longitudinal weights were used to account for non-response and attrition across waves, while CHARLS used cross-sectional weights to maintain representativeness in China’s 50+ population. The weights ensured that the composite score was representative of each study’s population, improving the generalizability of the results. Value of subdomain scores for intrinsic capacity: The using subdomain scores (cognitive, locomotor, sensory, psychological, and vitality) in understanding intrinsic capacity over time provides several advantages: • Cohort comparisons: Subdomain scores enabled detailed comparisons between birth cohorts, revealing that more recent cohorts entered older age with higher levels of capacity across all subdomains. Improvements were particularly significant in the locomotor, vitality, and cognition subdomains, showing nuanced gains in these specific areas. • Age-related declines: While intrinsic capacity declined with age, analysing subdomains separately showed that these declines varied. For instance, locomotor and cognitive declines were less steep for recent cohorts, highlighting specific areas where interventions may be most beneficial. Introduction1 Framework2 Indicators3 Best practices5 References Glossary 6 7 24 Measuring the progress and impact of the UN Decade of Healthy Ageing (2021–2030) Gaps 4 4.4 Closing data and information gaps A nation’s ability to collect, analyse and disseminate high quality data on ageing and inequalities is crucial for all stages of evidence-based decision-making and evaluation of the impact of national policies, legislations, strategies, action plans and programmes focusing on healthy ageing. Without meaningful and reliable data, decision-makers face critical difficulties in defining informed and successful public policy that is inclusive of the needs of older people (28). There is a significant geographic imbalance in data availability for older people. By 2030, it is estimated that 80% of the world’s older population (i.e. those aged 60 and above) will reside in LMICs (2). However, fewer than 10% of these countries routinely gather data on older persons through nationally representative population surveys (44,45). In many regions, information about the lived experiences of older persons is either fragmented or entirely absent. This issue is driven by inadequate data collection methodologies and approaches, leading to the invisibility of inequalities faced by older persons (28). Even when data is collected, the measures used are often not comparable (16). Hence, they require a systematic data harmonization exercise, which results in loss of granularity, introduces bias, over-simplifies complex variables, and reduces data integrity (49–51). WHO developed the Global Ageing Population Survey (GAPS) to address the data gap and generate comparable data worldwide. The overall aim is to collate and analyse valuable data that can be effectively utilized to formulate impactful policies and programmes, assess the efficacy of public health actions fostering healthy ageing, and enrich the lives of older people, their families, and the communities in which they live (see Box 3). In the coming years, WHO will continue to work with Member States to scale up the GAPS to generate reliable data for the 2026 and 2029 evaluation of the UN Decade of Healthy Ageing. • Detailed trajectories: Subdomain scores provided insights into the rate of change over time. For example, the vitality subdomain showed initially faster declines in younger cohorts but stabilized later, a pattern that would be missed if only the overall intrinsic capacity was considered. • Cultural comparisons: In the comparative analysis with CHARLS (China), subdomain scores revealed similar trends, with higher starting levels in more recent cohorts and less steep declines, but certain subdomains (e.g., psychological and sensory) showed different patterns, underscoring the importance of context in understanding aging. Overall, subdomain scores allowed for a more granular analysis, enabling a deeper understanding of specific domains of functioning and their contribution to healthy aging across populations. Introduction 1 Framework 2 Indicators 3 Best practices 5 References Glossary 6 7 254. Addressing data and measurement gaps – a way forward Gaps4 Box 3. WHO Global Ageing Population Survey What is GAPS? The WHO Global Ageing Population Survey (GAPS) is a robust and comprehensive survey developed by WHO in consultation with TAG4MHA. It is designed to generate valuable data on various outcome indicators (including 18 core indicators that require population data) relevant for monitoring the impact of healthy ageing policies, programmes and action plans on ageing populations. Implementation is prioritized in countries that currently lack a national survey on ageing. Aim: The overall aim is to collate and analyse valuable data that can be effectively utilized to formulate impactful policies and programmes, assess the efficacy of public health actions fostering healthy ageing, and enrich the lives of older persons, their families, and the communities in which they live. Study design: GAPS is designed to survey a cohort of nationally representative population of older persons (aged 60 years and over) over time. The participants will be recruited using a two-stage, stratified random sampling method. The first wave of data collection will be carried out in 2025–2026 in countries that expressed interest, and follow-up data will be conducted in 2028–2029. Survey instruments: The survey modules include household and individual interviews, including assessments and tests, to be conducted with eligible older people and their caregivers. The Household module covers range of topics including housing, electricity, water, sanitation, indoor air pollution, number of residences, household consumption and expenditures, ownership, household assets, household income, financial status of the house, environmental hazards and safety, overall financial situation and geospatial. The Individual module covers demographic, current occupation and work history, functional assessment, support for personal care, life- space mobility, anthropometric measurements, risk factors and health behaviours, nutritional intake, physical activity, health conditions, coverage of treatments, current medications, depression, health and home care service utilization, satisfaction with health care, social network types and support, community participation, neighbourhood safety, ageism, age friendliness of environment, loneliness, life satisfaction and well-being. Physical performance (e.g. gait speed, balance test, chair rise, hand grip strength, forced expiratory volume, blood pressure) and cognitive functions are assessed, and blood samples are also collected. The Caregivers module provides comprehensive information about caregivers, focusing on various aspects such as the care dependence level of those they care for, the extent to which caregiving impacts their employment (including cutting back on work), and the time they spend in caregiving activities. It also covers care arrangements, the health status of caregivers, the burden of caregiving, and caregivers’ subjective well-being. This data helps with understanding the challenges faced by caregivers and the impact of caregiving on their lives. The GAPS modules use questionnaires comparable to other ongoing ageing, health and retirement surveys around the world. The GAPS instruments are currently being piloted in countries. WHO prioritizes implementation of GAPS in countries where there is currently no national survey on ageing. For further information regarding GAPS, please write to TAGHA@who.int. Core Plus Survey Module Introduction1 Framework2 Indicators3 Best practices5 References Glossary 6 7 26 Measuring the progress and impact of the UN Decade of Healthy Ageing (2021–2030) Gaps 4 4.5 Preparation for 2026 and 2029 evaluations of the UN Decade of Healthy Ageing In response to the World Health Assembly request to track global progress made by WHO Member States in implementing the Decade, the core set of recommended indicators (Table 1) are prioritized for national, regional and global monitoring. Evaluating the progress and impact of the Decade actions involves different types of evaluation: process, outcome and impact evaluations. Each of these evaluations serves a distinct purpose and provides unique insights into the initiative’s progress, effectiveness and long-term impacts. In collaboration with other UN agencies and partners, WHO will review and update on the Decade progress, outcome and impact data in 2026 and 2029. These updates will be made available through scientific publications, the WHO Healthy ageing indicator portal, and global reports. An interim impact report will be published in 2026, followed by a final evaluation in 2029. To support effective monitoring, WHO works with its regional and country offices to assist Member States in data collection, validation and analysis, ensuring that these activities align with national monitoring objectives. Fig. 4 illustrates the data flow mechanisms for the Decade M&E framework. The data flow process for monitoring the global progress and impact of the UN Decade of Healthy Ageing is a structured multi-step procedure initiated by WHO. The process begins with WHO headquarters sending out requests for national data and/or retrieving it from publicly available sources. This data is collected by national focal points for ageing or WHO country offices, who work in collaboration with various national institutions including statistics offices, academic institutions, civil society organizations, and the private sector. The collected data is then submitted either directly to WHO or through WHO regional offices. Active senior men after a football match. ©Freepik Introduction 1 Framework 2 Indicators 3 Best practices 5 References Glossary 6 7 274. Addressing data and measurement gaps – a way forward Gaps4 Upon receipt of the data, WHO undertakes a comprehensive validation process in collaboration with the TAG4MHA members and respective countries. This process is designed to ensure the accuracy, consistency and reliability of the data collected. WHO reports global estimates for indicators in alignment with the Guidelines for accurate and transparent health estimates reporting, which establishes best practices for the transparent communication of health data (52). Additionally, before any formal release of estimates, the data undergoes a rigorous statistical clearance process, which includes review and approval by WHO Member States to ensure the integrity of the findings. Following the validation process, countries are given the opportunity to review the estimates produced by WHO, allowing them to verify the accuracy of the data within their national context. This step is essential for confirming that the estimates reflect the specific circumstances of each country, thus enhancing the overall credibility and applicability of the data. WHO publishes the validated data within the WHO Ageing data portal (53) and the Global Health Observatory, thereby facilitating global access and transparency. These platforms serve as critical resources for monitoring global progress and impact in relation to ageing initiatives, particularly those associated with the UN Decade of Healthy Ageing. By making this data publicly available, WHO supports ongoing efforts to track and analyse the impact of ageing-related policies and programmes, contributing to evidence-based decision- making and fostering a more comprehensive understanding of the global ageing landscape. Fig. 4. Data flow in three-level reporting for the UN Decade of Healthy Ageing monitoring and evaluation at the global, regional and national levels Data flow for monitoring global process and impact of UN Decade of Healthy Ageing: 1. WHO HQ send a requests for data to countries (or retrive it from publically avaialble oicial data sources) 2. National focal point for ageing and or/ WHO country oice or other designated personals to WHO Regional oices ot directly to WHO HQ 3. WHO validate DATA in consultation with the TAG4MHA and countries 4. Countries sign-o the estimates produced by WHO 5. WHO publishes the data in global report and in ageing data portal WHO Regional oices Academic institutions Civil society organizations Private sector WHO Country oice and national focal point for ageing in ministry National Statistical Oice Line Ministries and other national institutions Data and Metadata Adjusted, estimated or modified data World Health Organization Headquarters Global Ageing Database Global health observatory Introduction1 Framework2 Indicators3 Best practices5 References Glossary 6 7 28 Measuring the progress and impact of the UN Decade of Healthy Ageing (2021–2030) A man playing guitar on a sidewalk in Santa Fe, California. ©Freepik A man attending Aljanadriah, Riyadh, Saudi Arabia. ©Unsplash Best practices 5 5. Best practices for strengthening monitoring and evaluation systems in countries Strong national M&E is indispensable to tracking progress and evaluating the impact of public actions at the national and subnational levels. It is foundational for promoting transparency, accountability, learning, evidence-based decision-making, effective resource allocation and stakeholder engagement (7,8). According to the UN Decade process evaluation survey (6,7), approximately 81% of high-income countries, 86% of upper-middle-income countries, and 80% of low- and lower-middle-income countries have implemented a national policy, strategy or action plan on healthy ageing (Fig. 5). These findings show a strong global commitment to healthy ageing, with most countries across various income levels taking action. However, the ability of these countries to evaluate the effectiveness of their efforts and ensure accountability is compromised by significant M&E gaps. Notably, over 40% of countries lack an M&E plan, which is essential for tracking progress and making informed decisions based on evidence. Furthermore, nearly half of countries have not allocated a dedicated budget for the implementation and monitoring of these strategies, further diminishing their capacity to assess the impact of their healthy ageing initiatives. These shortcomings highlight the pressing need for a stronger commitment to enhancing national M&E systems. An effective, national-level monitoring system is the cornerstone of informed decision-making at subnational, national, regional and global levels, and is imperative for driving impactful policies and actions. The effectiveness of national M&E systems is contingent upon several key factors: a meticulously designed M&E plan; a comprehensive measurement framework; clearly defined indicators; reliable data; efficient dissemination of results; strong political commitment; adequate financial resources; and substantial technical capacity (8). This section offers best practice recommendations to strengthen national information systems for healthy ageing alongside real-world examples. The implementation of these recommended should be spearheaded by the national focal point or M&E team, with the active involvement of all concerned stakeholders in the country. Introduction 1 Framework 2 Indicators 3 Gaps 4 References Glossary 6 7 315. Best practices for strengthening monitoring and evaluation systems in countries Best practices5 Fig. 5. Countries with national monitoring and evaluation plans and dedicated budgets for a national strategy and action plan on ageing (as of 2020) 5.1 Developing a monitoring and evaluation plan An M&E plan is a comprehensive document that outlines how a given government will systematically track and assess the progress and impact of national strategies and action plans on healthy ageing. It includes clear M&E objectives, a detailed theory of change or logical framework that connects activities to desired outcomes, and specific indicators that measure progress at various levels. The plan specifies data collection methods, sources and schedules, along with protocols for data management, analysis and reporting. It also details the roles and responsibilities of the M&E team and relevant stakeholders, ensuring that all parties are engaged and contributing effectively. Additionally, the M&E plan includes strategies for disseminating findings, addressing ethical considerations, managing risks, and adapting the plan as needed. A budget section is included to outline the financial resources required and allocated for implementing M&E activities. A template for developing a comprehensive M&E plan is provided in the Annex 3, and recommended good practices for key areas are outlined below. Good practice recommendations i. Meaningful engagement • Inclusive participation. Involve a wide range of stakeholders, including policy-makers, older people, family caregivers, community leaders, health care professionals, architects, urban planners, researchers, long-term care providers, donors, programme implementers, national human rights institutions, private sector representatives, and community organisations (25). Diverse engagement ensures the M&E plan is comprehensive and National policy, strategy, action plan on healthy ageing Pe rc en ta ge o f c ou nt rie s 100 80 70 60 50 40 30 20 10 0 81.4 85.7 79.6 50 22.2 40.9 44 18.2 12.5 High Income (n=44) Upper-middle Income (n=36) Low & Lower-middle Income (n=56) No national M&E plan No dedicated budget Introduction1 Framework2 Indicators3 Gaps4 References Glossary 6 7 32 Measuring the progress and impact of the UN Decade of Healthy Ageing (2021–2030) Best practices 5 reflects multiple perspectives, fostering a sense of ownership and commitment among all parties (see Box 4). • Open communication channels. Establish open and regular communication channels to keep stakeholders informed throughout the M&E plan’s development and implementation. Transparent communication builds trust, enables ongoing feedback, and ensures stakeholders understand how decisions are made, particularly regarding indicator selection, data collection methods, and evaluation criteria. • Active participation of older persons. Ensure that older people are actively involved in the monitoring and evaluation process. Initiatives such as older citizen monitoring (OCM) empower older people to monitor the implementation of policies and services that impact their lives at the grassroots level (54). By involving older people in gathering evidence and advocating for change, the M&E plan becomes more reflective of their lived experiences, promoting policies and interventions that are responsive to their needs (see country example from Kyrgyzstan and Tajikistan in Box 5). ii. Mainstream national M&E plan with regional and global plans • Align objectives, priorities and goals. Identify key objectives of the national M&E plan on healthy ageing and ensure they are aligned with broader goals set by regional bodies (e.g. regional strategy for healthy ageing) and global initiatives (e.g. UN Decade of Healthy Ageing). For example, if the global plan emphasizes reducing ageism, ensure that national objectives contribute to this target by incorporating plans to track initiatives on combating ageism at the national or subnational levels. • Align indicators and metrics. Adopt indicators aligned with regional and global frameworks, such as WHO tracking of healthy life expectancy at age 60 (see Fig. 1 and Table 1). This ensures data comparability across multiple levels. Additionally, standardize data collection methods and tools to align with regional and global protocols, such as using the WHO GAPS survey tools to assess the healthy ageing status of older persons. This approach ensures that data collection activities are not only internally driven but also responsive to external benchmarks and expectations, allowing for a clear assessment of progress against international standards. • Align reporting cycles. To ensure timely data, synchronize national reporting timelines with regional and global schedules (e.g. WHO requires triennial reports on the UN Decade of Healthy Ageing, in 2023, 2026 and 2029). Alignment helps in the efficient allocation and use of resources by reducing duplication of efforts and focusing on shared priorities. It allows for the pooling of resources and expertise across different levels, ensuring that M&E efforts are both cost-effective and impactful. iii. Ensure sustainability, flexibility and responsiveness • Institutionalization. Integrate the M&E plan within national institutions and frameworks to ensure sustainability and long-term relevance. For example, the Kenya National Policy on Older Persons and Ageing embedded its M&E plan within the Ministry of Labour and Social Protection (55). This institutionalization helped maintain continuity during governmental transitions and ensured that ageing-related issues remained a national priority, regardless of political changes. • Capacity building. Invest in comprehensive training and capacity-building initiatives for all stakeholders involved in M&E activities. This strengthens stakeholders’ ability to monitor Introduction 1 Framework 2 Indicators 3 Gaps 4 References Glossary 6 7 335. Best practices for strengthening monitoring and evaluation systems in countries Best practices5 and evaluate programmes effectively, ensuring the M&E plan success and sustainability over time. • Secure resources. Secure adequate financial and human resources to sustain the M&E activities and to ensure their continuity and effectiveness. Allocating 5% to 10% of the national strategy on healthy ageing budget for M&E purposes is considered a good practice (56,57). • Adaptive planning. Design the M&E plan to be flexible, allowing for adjustments based on new evidence, emerging challenges, or changes in context. This ensures that the M&E system remains responsive to real-time data and evolving circumstances, enhancing its relevance and effectiveness. For instance, during the COVID-19 pandemic, many countries had to quickly adapt their M&E frameworks for health programmes, including those related to ageing, to address new public health challenges and shifting priorities. Such flexibility enables continuous improvement and ensures that the strategy remains aligned with current needs and realities (58). iv. Develop a comprehensive logical framework • Structure the framework. Create a logic model or results framework that clearly connects the components of your strategy, including inputs (resources), activities (actions undertaken), outputs (immediate results), outcomes (short- and medium-term changes), and impacts (long-term effects). This structured approach ensures that each element of the strategy is aligned and contributes to the overall goals of the national strategy on healthy ageing. For example, in a healthy ageing strategy, inputs may include funding, staff and medical supplies. Activities could involve health screenings and community outreach, with outputs such as the number of screenings conducted. Outcomes might focus on improved health indicators among older people, and impacts would target long-term health improvements and reduced health care costs. • Guide the M&E process. Use a logic model as the backbone for the M&E plan. This ensures that all data collection, analysis and reporting processes are systematically aligned with the framework. By doing so, each component of the strategy targeting older people is effectively tracked, allowing for a comprehensive assessment of progress. • Articulate the relationships. Clearly define how inputs lead to activities, how activities produce outputs, and how these outputs lead to desired outcomes and impacts for older people. This clarity helps demonstrate the logic behind the strategy and ensures that it is both theoretically sound and feasible. For instance, in a community health initiative targeting older people, the causal pathway might show that increased health care access (input) leads to more frequent check-ups (activity), resulting in earlier detection of conditions (output), leading to better-managed health (outcome), and ultimately a reduction in emergency hospital visits (impact). • Construct a visual representation. Develop a visual representation of the logical framework, typically using a diagram or flowchart, and include it in the M&E plan (see Box 6). This should clearly label each component and illustrate their causal relationships visually (59). A well-designed visual framework enhances understanding and helps communicate the strategy effectively to stakeholders. Introduction1 Framework2 Indicators3 Gaps4 References Glossary 6 7 34 Measuring the progress and impact of the UN Decade of Healthy Ageing (2021–2030) Best practices 5 v. Review and update regularly • Periodic review. Regularly evaluate the M&E plan to ensure it remains effective and relevant. This includes reassessing indicators, data collection methods and reporting processes to determine if they still align with the objectives and context of the programme. • Incorporate lessons learned. Continuously integrate insights from past monitoring cycles, evaluations and stakeholder feedback. This iterative process helps refine the M&E plan, making it more responsive and better suited to meet its goals. • Stay current. Keep the M&E plan up to date by incorporating new health, social and economic trends, adapting to policy changes, and leveraging technological advancements. This ensures the plan remains aligned with the latest developments and continues to effectively support decision-making and action (see Box 7). Box 4. Common challenges to ensuring widespread stakeholder engagement ‘Voice and engagement’ is an enabler of UN Decade of Healthy Ageing. It signifies that those in charge of developing and implementing the M&E plan need to include all concerned stakeholders, giving them the space and opportunity to freely express their views. Stakeholders comprise policy-makers, community leaders, civil society, professionals (e.g. health, social care, architects and designers, such as those focusing on housing, transport, technology), researchers in academic institutions, long-term care facilitates, donors, programme implementers in health and non-health sectors, heads of national human rights institutions, and key players in the private sector (e.g. insurance companies). In particular, older people (and their representatives) should be explicitly included as ‘concerned stakeholders’ in the development of M&E plans that affect them (25). In the context of M&E, ‘engagement’ implies a meaningful participation (i.e. stakeholders who are requested to participate are prepared and informed in an objective way and are allowed an adequate opportunity to express their voice). Participation by a greater number of people and a wider cross-section of society is preferred. The Decade encourages multisectoral engagement by Member States, UN agencies, civil society groups, service providers, academia and think-tanks, the private sector, and leaders of older people’s associations/organizations or older people themselves. Many countries may not conduct a stakeholder consultation during every stage of M&E activities, but it is necessary to capture population demands and expectations with some level of periodicity. Ensuring widespread participation often necessitates good and early preparation. This is because, depending on the political context of the country, dialogue and consensus must be sought at an early stage. This often involves engaging with stakeholders who may be less familiar or aligned with the programme, potentially leading to confrontation. This is an extra effort, and its importance is not to be underestimated in view of achieving broad adherence and alignment. Care should be given to supporting Participatory video for meaningful engagement of older people: a toolkit Introduction 1 Framework 2 Indicators 3 Gaps 4 References Glossary 6 7 355. Best practices for strengthening monitoring and evaluation systems in countries Best practices5 the participation of representatives from rural and hard-to-reach populations (e.g. older persons in long-term care institutions, living in remote areas, and who have particular language needs or face language barriers, or with low literacy). It may even be appropriate to organize separate consultative events to allow these groups to freely express their opinions. Ideally, the stakeholders who participate in M&E should have sufficient understanding of the issue, and be representative of all the categories of older people that should participate. In practice, however, it is not always easy to identify those representative stakeholders and enable them to participate. Note: For more information, see: Voice and meaningful engagement in the UN Decade of Healthy Ageing (25). Box 5. Closing the information gap on seasonal vulnerabilities in Kyrgyzstan and Tajikistan In 2010–11, older citizen monitoring (OCM) groups in 17 rural communities in Kyrgyzstan and Tajikistan undertook a year-long data collection effort from 170 households, focusing on various factors affecting healthy ageing. The study aimed to gather insights on seasonal changes, such as cold weather, agricultural cycles and labour migration, and their impact on the well-being of older adults, particularly in terms of poverty, health and access to essential services. This initiative was driven by a significant lack of evidence on how environmental factors such as cold weather influence the lives of older adults in Central Asia, which could be used to inform policy-making. Monitors conducted monthly visits to vulnerable households, gathering detailed information on daily living expenses such as the cost of food, fuel, health care and transport. They also collected data on income sources, including social assistance, and documented the health problems of household members. Monitors recorded indoor temperatures, tracked the presence or absence of household members due to work migration, and conducted interviews and group discussions with community leaders, local authority staff, and other community members. The data collected by OCM groups were analysed collaboratively by HelpAge International staff and the older citizen monitors in Kyrgyzstan and Tajikistan. Analysis revealed several challenges faced by older adults and vulnerable households, including limited employment opportunities for older people – older women in particular – inadequate health care services, rising costs and growing debt. It also highlighted that the monthly social assistance benefits provided by the government were insufficient to significantly alleviate these issues. ©Malik Alymkulov / HelpAge International Introduction1 Framework2 Indicators3 Gaps4 References Glossary 6 7 36 Measuring the progress and impact of the UN Decade of Healthy Ageing (2021–2030) Best practices 5 The evidence gathered through this monitoring process was presented at a conference organized by HelpAge in collaboration with respective ministries. Conference participants, including policy-makers and representatives from various sectors, were invited to develop recommendations based on the OCM findings, with the aim of improving the living conditions and well-being of older people in the region. Note: For more information, see: Older citizen monitoring: Achievements and learning (54). Box 6. Monitoring and evaluation framework using theory of change for the integrated careof older people in Salud en tu Casa, Mexico The monitoring and evaluation (M&E) framework for the integrated care of older people (ICOPE) approach in Mexico (60) provides a structured pathway to assess the effectiveness of interventions aimed at improving the intrinsic capacity (IC) of older people. The framework is based on the related theory of change and includes key components such as resources, identification, treatment, outcomes and impact, with specific indicators to monitor each. Resources and identification: The framework begins with ensuring the availability of health personnel and identification tools to conduct IC assessments at the first level of care. Health workers are trained to use ICOPE tools to assess deterioration in IC, with the assumption that they have access to necessary resources such as mobile devices and the internet. The programme identifies older people at risk and assesses their willingness to accept IC assessments. Treatment: Trained health workers carry out person-centred IC assessments, and patients are referred to multidisciplinary health teams when necessary. The teams consist of professionals from various fields such as medicine, nursing, nutrition and psychology. Treatment is delivered based on these assessments, and social support is offered through the provision of social benefits to those in need. Outcomes: The programme aims to develop personalized care plans for older people and improve their IC across various dimensions such as cognition, physical ability, psychological well-being, and sensory functions (e.g. hearing, vision). Management of identified risk factors is also a key outcome, with the expectation that timely and appropriate interventions will lead to measurable improvements in health. Impact: The long-term impact goals are to prevent, delay or reverse the decline in IC, improve the overall quality of life for older people, and raise their disability-free life expectancy. The programme’s success is measured through indicators such as the number of health workers trained, the number of referrals made, and the percentage of older people who show improvements in their IC and quality of life. Introduction 1 Framework 2 Indicators 3 Gaps 4 References Glossary 6 7 375. Best practices for strengthening monitoring and evaluation systems in countries Best practices5 Indicators and assumptions: The framework uses specific indicators to measure progress, such as the number of personalized care plans developed, and the improvements seen in IC dimensions. Key assumptions include access to health care, the use of social benefits, and the cooperation of older people in following care plans. These assumptions are critical for ensuring that the intervention operates effectively within the health care system. This M&E framework is designed to continuously assess and refine the ICOPE approach, ensuring that it meets its intended goals of improving health outcomes for older adults in Mexico. Gutiérrez-Barreto et al. 10.3389/fmed.2023.1166196 Frontiers in Medicine 04 frontiersin.org interventions and several preconditions to achieve long-term outcomes and contribute to the impacts. Narrative of the ToC The expected long-term outcomes are that (i) OP have personalized care plans and (ii) they improve in the ICOPE dimensions; the expected impact is the improvement in IC (17, 18). The outcomes imply that OP will change their health-related behaviors based on the recommendations of their personalized care plans. This outcome will modify some of the IC’s dimensions, e.g., improving their locomotion by using or receiving mobility aids, such as a cane. The long-term outcome indicators are time constrained and depend on the behavior of OP. Interventions The first intervention marked in Figure 1 as a star is the reach of the health program to manage the training. Before the first interventions and to activate the causal pathway of the ToC program, two preconditions are required: (1) availability of health personnel for the evaluation of IC at the first level and (2) availability of identification tools to health personnel. The second precondition assumes that the HCWs have access to an internet connection and a mobile device. As a rationale, there is evidence that using cognitive aids improves healthcare interventions (19). The indicators of both preconditions are that (i) a HCW is available to assess IC at the first level and (ii) a HCW uses the ICOPE application. The second intervention is managing training and the supervision of people-centered IC and person-centered assessment training. The preconditions before this intervention were that (3) healthcare workers were trained to assess the deterioration of IC with ICOPE and (4) OP would accept IC assessment. The fourth precondition assumes that OP have an environment to receive care from HCWs. During the third workshop, the health promoters mentioned that OP sometimes need a proper place to receive healthcare in their residences. Furthermore, in the workshop, they proposed explicitly identifying within the causal pathway the composition of the team responsible for providing healthcare at the different levels of diagnosis and treatment. The indicators for these preconditions are that (iii) HCW are trained to assess IC impairment and (iv) OP accept the assessment of the CI. At the “Treatment” level, the preconditions are that (5) healthcare workers are competent in conducting a people-centered IC assessment, (6) the referral to the health team is done appropriately and functionally, (7) people identified with risk factors attend or receive health services, and (8) management and opportunity are given to improve the social support of the identified persons by sending them social benefits. The referral system’s precondition depends on using the existing system when requested. This assumption was discussed during the third workshop by the HCWs, who expressed concerns about the reference system’s lack of supervision. The rationale for using an electronic reference system is the evidence supporting its use to increase interprofessional communication and leadership (20). The sixth and seventh preconditions assume that the other social programs offered to OP are used for the purposes recommended by HCWs and that OP have the means to attend health services. The stakeholders discussed these preconditions in the second workshop; the central comment was the motivation of HCWs to provide care and of OP to FIGURE 1 Theory of Change of the Integrated Care for Older People in Salud en tu Casa. Box 7. Building M&E practices in South Africa Using a holistic support model, Neighborhood Old Age Homes (NOAH) – a nonprofit rg nization bas d in South Africa’s West rn Cap – provides safe, affordable hou ng to elderly individuals living in poverty. Operating across six communities in greater ©Neighborhood Old Age Homes Introduction1 Framework2 Indicators3 Gaps4 References Glossary 6 7 38 Measuring the progress and impact of the UN Decade of Healthy Ageing (2021–2030) Best practices 5 Cape Town, NOAH focuses on six key areas of support: home, health, happiness, social enterprise development, sustainability, and organizational development. The organization currently meets the basic needs of over 730 social pensioners, with twelve communal houses and two community centres that offer psychosocial support and community-based care through NOAH clinics in Woodstock and Khayelitsha. Strengthening M&E practices Recognizing the importance of effective M&E, NOAH undertook significant efforts to enhance its M&E framework by revising its theory of change. The goal was to not only monitor access to services but also to reflect the broader impact of the organization’s work within the communities it serves. This shift from focusing solely on service delivery outputs to evaluating the outcomes and impacts of its interventions marked a significant transformation in the NOAH approach to M&E. In 2020, NOAH hired an M&E consultant to work closely with programme managers. This decision followed a gap analysis that highlighted the need for a dedicated M&E function within the organization. The consultant played a crucial role in streamlining data collection processes, embedding M&E practices into the overall management structure, and ensuring that programme plans were aligned with NOAH’s logic framework model. Implementation and impact As a result of these changes, NOAH moved from inconsistent and ad hoc monitoring to a more structured and systematic approach. Key programme areas now have monthly monitoring and reporting, with outcomes evaluated against set targets. Formal evaluation learnings have been integrated into the organization’s planning processes, allowing for continuous improvement and adaptability. M&E has become an integral part of NOAH organizational development, informing strategic planning rather than being treated as an ‘add-on’ activity. This shift has led to a deeper internal awareness of the value of sound M&E practices and has created an enabling environment where data-driven decision-making is prioritized. Shifting organizational culture The practical integration of data into NOAH daily operations has had a transformative effect on the organization’s culture. This was exemplified by the experience of the health manager who initially resisted M&E, viewing it as an administrative burden. However, as the health manager began collecting health data for a diabetes support group, the data revealed tangible improvements in the group’s health outcomes. Over time, the group members effectively supported each other in managing their diabetes, leading to better health results. The visible impact of M&E on the group’s success led the health manager to embrace the value of M&E. The NOAH journey to strengthen its M&E practices demonstrates the importance of integrating M&E into the core operations of an organization. By focusing on outcomes rather than simply outputs, NOAH has been able to better understand and enhance the impact of its work in the communities it serves. The organization’s commitment to continuous learning and adaptation, supported by robust M&E practices, has positioned NOAH as a model for other NPOs aiming to achieve sustainable and meaningful impact. Note: For more information, see: https://noah.org.za/. Introduction 1 Framework 2 Indicators 3 Gaps 4 References Glossary 6 7 395. Best practices for strengthening monitoring and evaluation systems in countries Best practices5 5.2 Select a balanced set of indicators Selecting a balanced set of indicators is fundamental to effectively monitoring and evaluating a national strategy on healthy ageing (NSHA). A well-rounded set of indicators ensures comprehensive assessment across different dimensions of healthy ageing, capturing both quantitative and qualitative aspects. These indicators should be aligned with the NSHA objectives and targets, be sensitive to changes over time, and be able to provide meaningful insights for policy development and programme improvement. Good practice recommendations i. Ensuring comprehensive coverage • Review the M&E framework. Identify critical domains for the NSHA, such as access to care services, intergenerational activities, age-friendliness of the environment, functional ability, and long and healthy lives. Ensure that selected indicators cover all critical aspects of domains, providing a holistic view of progress and challenges. For instance, to monitor its National positive ageing strategy, the Ireland Ministry of Health developed a set of 56 national indicators, which cover participation, healthy ageing, security, and cross-cutting areas aligned with domains of focus of (61). • Focus on high-impact, sensitive indicators: Prioritize indicators that are most sensitive to changes and directly linked to the desired outcomes. For instance, measuring improvements in functional ability and access to care services can provide a clearer, more direct understanding of how well the intervention is working, compared to a broad range of less impactful measures. Sensitive indicators help capture key shifts in the population’s well-being without overwhelming the monitoring system. • Balance the distribution of indicators. To improve the effectiveness of monitoring systems, it is essential to ensure a balanced distribution of indicators across various domains. Areas such as health care services are often allocated a disproportionately large number of indicators, which can overshadow critical areas such as age-friendliness of the environment, ageism, intrinsic capacity or functional ability (62). By promoting a more even distribution, monitoring systems can offer a comprehensive overview of health and societal well-being, effectively capturing the complex interplay of diverse factors that impact outcomes. ii. Balance between output, outcome and impact indicators • A balanced set of indicators should include measures at various levels: – Input indicators. Measures related to the resources and investments allocated to the strategy (e.g. amount of funding allocated, number of trained health care professionals, and quantity of facilities or equipment provided). – Process indicators. Measures related to the activities and processes implemented as part of the strategy (e.g. percentage of planned health programmes implemented, adherence to protocols in service delivery, and frequency of community outreach events). – Output indicators. Measure the immediate results of activities (e.g. the number of older people receiving a particular service). Introduction1 Framework2 Indicators3 Gaps4 References Glossary 6 7 40 Measuring the progress and impact of the UN Decade of Healthy Ageing (2021–2030) Best practices 5 – Outcome indicators. Capture the short- and medium-term effects of outputs (e.g. improvements in functional ability or well-being). – Impact indicators. Assess the long-term effects and overall goals of the NSHA (e.g. increased life expectancy). iii. Incorporate both quantitative and qualitative indicators • Quantitative indicators provide measurable data that can be easily tracked over time (e.g. prevalence of undernutrition among older people). Qualitative indicators capture more nuanced aspects of ageing, such as perceptions of social inclusion or satisfaction with services or life. iv. Use criteria for indicator selection • Relevant. Select indicators that are specific to the goals of the healthy ageing strategy and directly relevant to the outcomes being monitored. • Measurable and achievable. Ensure indicators are measurable with available resources and that targets are realistic and achievable within the given time frame. • Time-bound. Set clear timelines for achieving targets to enable regular tracking and timely adjustments. v. Assess feasibility • Data collection. Evaluate the ease and accuracy with which data can be collected for each indicator. Identify any challenges or barriers encountered during data collection. • Resource requirements. Assess the resources required for data collection, including time, personnel and financial costs. Ensure that these requirements are realistic and sustainable for full-scale implementation. • Data quality. Check the quality of data collected, focusing on completeness, consistency and accuracy. Identify any sources of bias or errors. vi. Leverage existing frameworks and standards • Utilize existing frameworks and standards for selecting indicators, such as those recommended by WHO and other international bodies. This ensures consistency and comparability with global benchmarks and facilitates national data integration into broader international monitoring efforts. See Canada country example in Box 8 on selection of indicators. • Align the metadata structure and components with those recommended in the WHO Healthy ageing indicator toolkit to ensure consistency, accuracy and efficiency in data management and evaluation. This will promote reliable comparisons, facilitate effective data sharing, and enhance overall data quality and stakeholder communication at different levels. Introduction 1 Framework 2 Indicators 3 Gaps 4 References Glossary 6 7 415. Best practices for strengthening monitoring and evaluation systems in countries Best practices5 vii. Validate indicators • Pilot indicators. Pilot the selected indicators before full-scale implementation to ensure their feasibility and reliability. Validate the indicators through consultations with stakeholders and experts to confirm their appropriateness and effectiveness in capturing the desired information (36). • Modify Indicators. Based on the findings from the pilot studies and stakeholder consultations, make necessary adjustments to the indicators. This may involve redefining indicators, modifying data collection methods, or addressing any other identified issues. • Retest adjusted indicators. If significant changes are made, consider conducting a second, smaller pilot to test the adjusted indicators. Ensure that these adjustments have resolved the identified issues without introducing new problems. • Documentation. Create comprehensive guidelines and protocols for implementing the indicators. These should include detailed instructions for data collection, management and reporting of healthy ageing indicators. Box 8. Age-friendly communities evaluation guide to measure progress in Canada The Public Health Agency of Canada (PHAC) has developed the Age-friendly communities evaluation guide for assisting communities in effectively measuring and evaluating their age-friendly initiatives (63). This initiative aimed to support monitoring communities that create environments enabling older people to stay healthy, active and independent, while continuing to contribute meaningfully to society as they age. Process for indicator selection To identify relevant indicators, PHAC developed an initial ‘long list’ of over 200 potential indicators, based on a literature review, as well as existing age-friendly documentation and reports. While the list of indicators was comprehensive, it was also far too long and unwieldy to be practical. Through extensive consultation with stakeholders, the agency streamlined the list to a final ‘menu’ of 43 indicators across eight age-friendly communities (AFC) domains, as well as health and social outcomes for older people. The final selection reflects stakeholders’ needs for indicators that are important, feasible (to measure) and actionable. It also reflects their frequency in the literature and documents reviewed. For age-friendly environment framework development and domain selection, please refer to National programmes for age- friendly cities and communities: a guide (19). • Actionable. The Indicators can be influenced by the local or regional community, government or private sector and are likely to show change in response to action. • Feasible. Data for the indicator are measurable (e.g. from a survey or administrative data) or describable (e.g. with a photo or story) in a realistic manner and without obstacles to collection or use. Indicators were further categorized for measuring the short-, medium- and long-term impact of AFC. Indicators were classified under measurement domains reported in this document (see Fig.6). Introduction1 Framework2 Indicators3 Gaps4 References Glossary 6 7 42 Measuring the progress and impact of the UN Decade of Healthy Ageing (2021–2030) Best practices 5 Fig. 6. Eight domains for age-friendly action Physical Environm ent Social Environmen t M un ici pa l S erv ice s Community and health services Outdoor environments Civic engagement and employment Communication and information Transport and mobility Social inclusion and non- discrimination Housing Social participation Age-Friendly Environments The PHAC guide offers valuable lessons in effectively selecting and utilizing indicators to measure progress in age-friendly initiatives: • Streamlining indicators. Initially, PHAC developed a comprehensive list of over 200 potential indicators based on a thorough review of literature, age-friendly documentation and reports. However, this extensive list proved impractical for application. Through extensive stakeholder consultations, the list was refined to a more manageable 43 indicators across eight AFC domains, focusing on health and social outcomes for older people. This process highlighted the importance of prioritizing indicators that are not only relevant but also feasible and actionable. • Importance of stakeholder engagement. The success of the indicator refinement process underscores the critical role of engaging stakeholders. By involving local communities, government bodies and the private sector in the decision-making process, PHAC ensured that the final set of indicators addressed real-world needs and could be realistically implemented. • Actionability and feasibility. The selected indicators were chosen based on these two key criteria. Indicators were deemed actionable if they could be influenced by local or regional communities, government or the private sector, and if they were likely to reflect changes resulting from interventions. Feasibility was assessed based on whether the data for the indicators could be realistically measured or described without significant obstacles. This approach ensured that the indicators would not only be relevant but also practical to implement and track over time. • Categorization for impact measurement. The indicators were categorized to measure short-, medium-, and long-term impacts of AFC initiatives, ensuring a Introduction 1 Framework 2 Indicators 3 Gaps 4 References Glossary 6 7 435. Best practices for strengthening monitoring and evaluation systems in countries Best practices5 5.3 Establish baselines and targets The establishment of baselines and setting of targets are foundational components in creating a structured framework for continuous monitoring, evaluation, and improvement within a national strategy for healthy ageing (64). These processes are critical to ensuring that the strategy remains aligned with its stated objectives and is responsive to the evolving needs of the population. Furthermore, establishing baselines and setting targets are pivotal in fostering accountability by clearly defining the criteria for success. They also play a significant role in promoting stakeholder engagement, collaboration and ownership, which are essential for the effective implementation and achievement of national healthy ageing strategy goals. Good practice recommendations i. Set clear and measurable targets • Specificity. Clearly define targets that are specific and measurable. Health Japan 21 (second term) set precise targets for extending healthy life expectancy and reducing health disparities, providing a clear framework for evaluating progress. For example, the target to extend healthy life expectancy beyond the increase in life expectancy by 2022 is a specific, measurable goal that directly addresses the programme’s overarching objective of improving public health (see Box 9). • Time-bound. Ensure targets are specific, measurable and time-bound. For example, the Healthy China 2030 blueprint, a national strategy, aimed to increase the average life expectancy at birth from 76.3 years in 2015 to 79 years in 2030, and 80 years in 2035 (65). This clarity helps guide actions and allows for precise time frame for measurement of progress. See the Healthy People 2030 example in Box 10 for target-setting methods (66). ii. Establish good baselines • Accurate baseline data. To effectively measure progress, it is essential to establish baselines using the most up-to-date and accurate data available (67). Japan’s approach in the Health Japan 21 (second term) initiative serves as a strong example, where 2010 data on healthy life expectancy and regional disparities were used as the foundational baseline for setting targets. Specifically, in 2010, the healthy life expectancy was 70.42 years for men and 73.63 years for women, with notable differences across Japan’s prefectures. These comprehensive evaluation framework. This categorization allowed for continuous monitoring and adaptation, facilitating the measurement of progress over different timeframes. • Utilizing existing frameworks. PHAC’s work also demonstrates the value of leveraging existing frameworks, such as the WHO guide on national programmes for age- friendly cities and communities. By aligning with established global standards, the PHAC AFC guide ensures consistency and comparability with broader age-friendly initiatives. These lessons emphasize the importance of careful indicator selection, stakeholder engagement and alignment with global standards in developing effective monitoring and evaluation frameworks for age-friendly communities. Introduction1 Framework2 Indicators3 Gaps4 References Glossary 6 7 44 Measuring the progress and impact of the UN Decade of Healthy Ageing (2021–2030) Best practices 5 figures provided a clear and robust starting point for assessing future improvements. Data collection should be standardized across regions to ensure comparability and accuracy, thereby creating a reliable reference point for evaluating the effectiveness of interventions and achieving the strategy’s goals. • Driving continuous improvement. As monitoring reveals progress or highlights areas needing more effort, the government can make timely adjustments, ensuring that the strategy evolves in response to real-world outcomes Continuously monitor and analyse data to track progress toward targets. By continuously tracking the gap between healthy life expectancy and total life expectancy, Japan ensured that progress remained on track and adjusted strategies as necessary (68). iii. Engage stakeholders in the target-setting process • Stakeholder involvement. Engage stakeholders, including local governments and communities, in setting and achieving targets. Their insights can help ensure targets are realistic and address key concerns. Seek agreement from stakeholders on targets to promote ownership and commitment to achieving them. Japan’s success in reducing health disparities among prefectures was likely supported by the involvement of regional governments in implementing and monitoring health strategies. • Collaborative decision-making. Establish formal mechanisms for stakeholder collaboration, such as working groups or advisory committees, to ensure that the target-setting process is participatory, and decisions are made collectively. iv. Target-setting methodologies • Use diverse methods. Utilize a variety of target-setting methods, such as percent improvement, percentage point improvement, projections and minimal statistical significance, to tailor targets to specific contexts and ensure they are both ambitious and realistic. This approach allows for flexibility and precision in setting meaningful health improvement goals (66). • Prioritize data-driven approaches. Leverage statistical models, trend analysis and historical data to establish targets that are grounded in evidence. Tools such as the Trend analysis tool can be instrumental in predicting future outcomes and identifying achievable targets based on data trends (see Box 10). • Ensure statistical significance. Incorporate minimal statistical significance in the target- setting process to ensure that targets represent meaningful changes. This helps avoid setting arbitrary goals and enhances the credibility of the targets. v. Promote transparency and public accountability • Transparency in reporting. Transparency fosters accountability and encourages continuous engagement and support for the strategy. Communicate targets and progress transparently to stakeholders and the public. This fosters accountability and encourages stakeholder engagement. Maintain detailed records of target-setting processes, including the rationale for chosen targets and any assumptions made. • Public engagement. Create opportunities for public feedback on progress reports and adjustments to the strategy. Public consultations, town hall meetings or online forums can help gather input and maintain public trust. Introduction 1 Framework 2 Indicators 3 Gaps 4 References Glossary 6 7 455. Best practices for strengthening monitoring and evaluation systems in countries Best practices5 • Independent audits. Consider conducting independent audits or evaluations of the progress towards targets to ensure transparency and objectivity. Sharing the results of these audits with the public further reinforces accountability. Box 9. Taking a leap forward in healthy life expectancy in Japan Initiated in 2013, Health Japan 21 (the second term) aims to extend healthy life expectancy and reduce health disparities, establishing targets in 53 specific areas. To achieve these targets, it is necessary to continuously investigate and analyse numerical data for the main items and understand variations in health status and lifestyle habits within the prefectures. The overarching goal of this programme is to achieve a vibrant society where all citizens live healthy and spiritually rich lives. Action area 1 focuses on extending healthy life expectancy and reducing health disparities. Two targets were set to track the progress and measure the impact (see table 2 below) (68). Table 2. Targets for achieving extension of healthy life expectancy and reduction of health disparities Indicators Current data Target 1. Extension of healthy life expectancy (average period of time spent without limitation in daily activities) Male: 70.42 years Female: 73.62 years (2010) To extend healthy life expectancy more than the increase of life expectancy (2022) 2. Reduction of health disparities (gap among prefectures in average period of time spent without limitation in daily activities) Male: 2.79 years Female: 2.95 years (2010) Reduction in the gap among prefectures (2022) Evaluation results: Healthy life expectancy in 2010 in Japan was 70.42 years for men and 73.63 years for women. Total life expectancy in 2010 was 79.55 years for men and 85.99 years for women. Accordingly, the gap between total life expectancy and healthy life expectancy (i.e. the life years spent in an unhealthy state) was 9.13 years for men and 12.36 years for women. There is a vast difference in the healthy life expectancy among the 47 prefectures in Japan. In 2010, the difference between prefectures with the longest and shortest healthy life expectancies was 2.79 years for men and 2.95 years for women. The first target of Health Japan 21 (second term) is to extend healthy life expectancy beyond the increase by 2022. Achieving this target would reduce the number of life years spent in an unhealthy state, hence enhancing the quality of life among the people and decreasing social security expenditure. The evaluation results in 2019 indicated that this target has been achieved. The gap between healthy life expectancy and the increase in life expectancy was narrowed, with the number of life years spent in an unhealthy state decreasing for men and women. The second target of Health Japan 21 (second term) is to reduce the disparity in healthy life expectancy among prefectures. The evaluation indicated that the difference between prefectures with the longest and shortest healthy life expectancy decreased. Therefore, it is concluded that the first target of Health Japan 21 (second term) has been achieved. Introduction1 Framework2 Indicators3 Gaps4 References Glossary 6 7 46 Measuring the progress and impact of the UN Decade of Healthy Ageing (2021–2030) Best practices 5 Lessons Learned: Japan’s Health Japan 21 (second term) initiative, launched in 2013, provides valuable lessons in setting and achieving ambitious public health goals, particularly in extending healthy life expectancy and reducing health disparities across regions: • Setting clear, measurable targets. One of the key lessons from Japan’s approach is the importance of setting clear, measurable targets. By defining specific indicators – such as the extension of healthy life expectancy and the reduction of disparities among prefectures – Japan was able to track progress effectively. This clear focus on measurable outcomes enabled continuous monitoring and evaluation, ensuring that the program stayed on track toward its goals. • Continuous data analysis and monitoring. Another critical lesson is the need for continuous investigation and analysis of numerical data. Japan’s approach involved regularly collecting and analysing data on health status and lifestyle habits across its prefectures. This continuous monitoring allowed for the identification of trends and variations in health outcomes, enabling timely interventions to address emerging issues and disparities. • Addressing regional disparities. Japan’s focus on reducing health disparities between prefectures highlights the importance of addressing regional inequalities in public health. By targeting reductions in the gap between the healthiest and least healthy regions, the programme not only aimed to improve overall health outcomes but also sought to ensure that these improvements were equitably distributed across the population. • Achieving impact through focused action. The evaluation of Health Japan 21 (second term) demonstrated that focused actions can lead to significant improvements in public health. The initiative successfully extended healthy life expectancy beyond the increase in total life expectancy, thereby reducing the number of years spent in an unhealthy state. This achievement not only enhanced the quality of life for Japan’s population but also helped decrease social security expenditures. • Importance of regular evaluation. Regular evaluation of the initiative’s progress was key to its success. The 2019 evaluation results showed that the targets set in 2013 had been achieved, demonstrating the effectiveness of continuous assessment and adjustment in public health programmes. Overall, Japan’s experience with Health Japan 21 underscores the importance of setting clear targets, continuous data monitoring, addressing regional disparities, and conducting regular evaluations to achieve impactful and sustainable public health outcomes. Introduction 1 Framework 2 Indicators 3 Gaps 4 References Glossary 6 7 475. Best practices for strengthening monitoring and evaluation systems in countries Best practices5 Box 10. Healthy People 2030 target-setting methods Healthy People 2030 is an initiative in the United States of America that aims to improve public health by setting data-driven targets. Managed by the National Center for Health Statistics (NCHS), it emphasizes transparency and realism in target-setting. The initiative employs various methods to establish targets for health improvements (66). Methodologies • Percent improvement. Targets are based on a 10% or 20% improvement from baseline. • Percentage point improvement. Uses Cohen’s h effect size for precise adjustments. • Projection. Statistical models and trend analysis predict future outcomes. • Minimal statistical significance. Ensures targets reflect statistically significant changes. • Consistency with national programmes/maintaining baseline. Aligns with national priorities and maintains targets where objectives have met goals. Trend analysis tool. Provides candidate targets projections based on linear trend analysis. Specifically, weighted or ordinary least squares is used to fit a trend line based on historical data, resulting in predicted values (these can be used as candidate targets) using up to seven confidence levels (69). Percent improvement and minimal statistical significance tool. Using the baseline (initial) value only to calculate a percent or percentage point, the Percent improvement and minimal statistical significance tool provides up to two candidate targets. If the standard error is available, then an additional candidate target, based on minimal statistical significance, is also provided (69). Implementation and transparency The process is transparent, with justifications for target-setting available for public review, integrating expert opinions and current health policies. Impact and future directions Healthy People 2030 offers a framework that balances ambitious goals with achievable targets, serving as a model for future public health initiatives. The systematic approach ensures that health improvements are significant and aligned with broader health policy objectives. Introduction1 Framework2 Indicators3 Gaps4 References Glossary 6 7 48 Measuring the progress and impact of the UN Decade of Healthy Ageing (2021–2030) Best practices 5 5.4 Strengthening data and information systems Data are the lifeblood of robust monitoring and evaluation systems. Strengthening data and information systems is essential for the effective implementation and continuous monitoring of healthy ageing strategies at all levels. This process requires enhancing the quality, scope and accessibility of data across all key indicators. By advancing data systems, it becomes possible to ensure that decisions are well-informed, interventions are accurately targeted, and the evolving needs of older populations are addressed with timely and effective responses. Good practice recommendations i. Standardize data collection methods • Implement standard protocols. Utilize standardized protocols and tools for data collection across health care and social services providers at all levels. This ensures consistency and comparability of data related to healthy ageing indicators (see Box 11). • Ensure consistent training. Provide regular training to data collectors to ensure they are well-versed in the standardized methods and protocols, minimizing variability in data collection. Fig. 7. Health People 2030: Target-setting method selection Target-setting method: Projection Tool: Trend analysis tool 1Data points are considered comparable if the data were collected using the same data system, methods, and question(s). NOTES: TSM is target-setting method. MSS is minimal statistical significance. SOURCES: National Center for Health Statistics and Department of Health and Human Services, O…ice of Disease Prevention and Health Promotion, HP2030. A) Start here B) Should the target be consistent with an existing national program, regulation, policy, or law? C) Is the baseline already where you want to be? D) Are there three or more comparable1 data points? E) Has modeling or a trend analysis already been conducted? F) Use the Trend Analysis Tool; should the target be based on a projection? G) Should the target be consistent with model or trend analysis provided by the workgroup? Target-setting method: Maintain consistency with national programs, regulations, policies, or laws Target-setting method: Maintain baseline You may choose a method other than the recommended method (additional justification will be required). Target-setting method: Percent improvement or Minimal statistical significance Tool: Percent improvement and Minimal statistical significance tool yesyes yesyes yes yes no no no no Introduction 1 Framework 2 Indicators 3 Gaps 4 References Glossary 6 7 495. Best practices for strengthening monitoring and evaluation systems in countries Best practices5 • Use common data elements. Establish common data elements across different regions and service providers to ensure that all data are collected in a uniform manner, facilitating easier comparison and analysis across settings. ii. Follow WHO recommendation for data disaggregation: Promote collection and analysis of disaggregated data to better understand the specific needs and trends among older people (see Box 12). This granularity enables targeted interventions and policies tailored to different groups within the older population. Ensure ethical considerations • Uphold ethical standards. Adhere to ethical guidelines in data collection, storage and use, including informed consent, confidentiality and data protection. Ensuring that ethical standards are met fosters trust among older people and ensures responsible handling of their health information (27). • Incorporate cultural sensitivity. Ensure that data collection methods and tools are culturally sensitive and appropriate for the diverse populations within the older age group, respecting their values and preferences (28). • Protect vulnerable populations. Take additional steps to ensure that the most vulnerable and frail individuals are not excluded from data collection and that their rights are protected throughout the process (26). iii. Integrate data sources • Cross-sectoral data integration. Integrate diverse data sources – such as health records, surveys, administrative databases and population surveys – to provide a comprehensive view of healthy ageing trends. This integration facilitates more robust monitoring and evaluation of public interventions. • Develop interoperable systems. Ensure that data systems across different sectors (e.g. health care, social services and housing) are interoperable, allowing for seamless data exchange and integration. • Facilitate longitudinal analysis. By integrating data sources over time, enable longitudinal analysis that can track changes and trends in the ageing population, providing deeper insights into the long-term impact of interventions. iv. Managing missing data • Assess and address missing data. Evaluate the nature of missing data, understanding its impact on measurements and conclusions. Classify missing data as ‘missing completely at random’, ‘missing at random’ or ‘missing not at random’ (70). • Implement data imputation techniques. Where feasible and appropriate, apply statistical methods to impute missing data, ensuring that analyses are not compromised by incomplete datasets (71). • Regularly review data quality. Conduct regular reviews to identify patterns in missing data and take corrective actions to reduce data gaps in future collection efforts. Implement robust mechanisms for data quality assurance, including regular audits, validation processes, and training for data collectors. This ensures data accuracy, completeness and reliability for monitoring and evaluation purposes. See the WHO Data quality assurance framework (72) for more information. Introduction1 Framework2 Indicators3 Gaps4 References Glossary 6 7 50 Measuring the progress and impact of the UN Decade of Healthy Ageing (2021–2030) Best practices 5 v. Utilize technology for data collection and management • Leverage digital tools. Use digital technologies such as electronic health records and data analytics platforms to streamline data collection, storage, analysis and reporting (73). These tools enhance the efficiency and timeliness of generating insights from data for evidence-based decision-making. • Integrate digital biomarkers. Remote sensors and wearable devices, such as smartwatches and fitness trackers, provide real-time data on various health indicators, including physical activity, heart rate, sleep patterns, falls risk and more. This continuous stream of data enhances the quality, scope and timeliness of health information, allowing for more accurate monitoring of older persons’ health and well-being (74). Despite the promise of a multitude of sensors and devices that can be used, there are no agreed-upon standards for digital biomarkers, nor are there comprehensive evidence-based results for which digital biomarkers may be demonstrated to be most effective (75,76). Therefore, feasibility and efficacy of digital biomarkers in routine monitoring must be carefully assessed before implementation. • Adopt advanced analytics. Utilize advanced data analytics techniques, including machine learning and predictive modelling, to extract deeper insights from collected data and anticipate future trends in healthy ageing (77). • Ensure data security. Implement robust cybersecurity measures to protect sensitive health information, ensuring that data privacy and integrity are always maintained. vi. Foster international and national collaborations • Harmonize global standards. Collaborate with international organizations, research institutions and global health initiatives to harmonize data collection standards (e.g. through use of the Maelstrom guidelines) and share best practices. Leverage global datasets for comparative analysis of healthy ageing trends (51). • Participate in global networks. Join global networks (e.g. Gateway to Global Ageing Data) focused on healthy ageing data and research, thereby contributing to and benefiting from the collective knowledge and experience of the international community (78). • Facilitate data sharing and collaboration. Foster partnerships and collaborations among stakeholders, including government agencies, academia, nongovernmental organizations, and the private sector, to facilitate data sharing and joint analyses. This collaborative approach promotes knowledge sharing and strengthens the evidence base for effective healthy ageing strategies. • Continuous improvement. Establish a culture of continuous improvement by soliciting feedback from stakeholders, evaluating the impact of data use on decision-making, and adapting data systems and strategies in response to evolving needs and priorities in healthy ageing (79). Introduction 1 Framework 2 Indicators 3 Gaps 4 References Glossary 6 7 515. Best practices for strengthening monitoring and evaluation systems in countries Best practices5 Box 11. Healthy ageing toolkit for data comparison from ageing cohort studies around the world Evidence from population-based cohort studies is vital to understand healthy ageing and drivers of healthy ageing inequities. Over recent decades, many ageing cohort studies have been established globally. Yet, the availability of longitudinal data with a rich set of measurements in the context of healthy ageing, as defined by WHO, remains unclear. A multifaceted search strategy identified and systemized information on 287 existing cohort studies across the globe and their available measurements to study healthy ageing. Data on key characteristics of the cohort studies, including region, country, the aim of the cohort studies, sample size, age distribution at baseline, study duration, and the number of follow-up waves, were extracted. Focusing on the WHO definition of healthy ageing, data availability on demographics, socioeconomic circumstances and environmental factors, as well as the various intrinsic capacity domains measured in each cohort study, were also extracted (80). Using the findings from this review, the Healthy ageing toolkit, a free searchable online cohort study information repository, was developed (81). The toolkit is a free public resource designed to help researchers easily find information globally on cohort studies with relevant sets of measurements on intrinsic capacity, as well as social and environmental factors, to promote the use of available data and facilitate multi-cohort and cross-national comparison research on healthy ageing and its trajectories, as well as inequities in healthy ageing. The toolkit also identifies the healthy ageing data collection gaps that need to be addressed, further supporting the global, regional and national monitoring of actions, programmes and policies. This information has never before been available in an aggregated and accessible form and has the potential to transform research and underpin efforts in the area of healthy ageing. Introduction1 Framework2 Indicators3 Gaps4 References Glossary 6 7 52 Measuring the progress and impact of the UN Decade of Healthy Ageing (2021–2030) Best practices 5 Box 12. WHO recommendation on age disaggregation of data on older persons Recommended standardized age disaggregation groups for ageing data 60–99 years, grouped in 5-year intervals, plus a category for people older than 100 years. If data for highest age group (e.g. 100+) is limited, it may be appropriate to group with next possible interval (e.g. 85+) (82). While WHO strongly advocates for the proposed age disaggregation, it acknowledges that in certain cases, broader or more detailed age groupings may be required. These adjustments should be based on the needs of health programme planning and implementation, or the natural history of specific diseases/conditions. Age ranges and the number of age groups may vary depending on the condition, considering the disease burden, associated risk factors, and relevant policies and programmes. Recommended age disaggregation to report data on older people • Collect exact age or birth date whenever possible, allowing for many different age groupings. • Use the WHO standard recommended age disaggregation when reporting on health data, especially when reporting on multiple diseases simultaneously, or a not previously recognized disease/condition. • Disaggregate by sex, especially when differences by sex are important within specific age groupings. • Consider deviations from these age groupings only when necessary, such as health service provision requirements or in case of methodological or statistical limitations. • Disaggregate by other essential parameters, such as education, wealth and place of residence (e.g. cities, towns, semi-dense areas, and rural areas) (83). For further information on making older people visible, please refer to Making older persons visible in the sustainable development goals’ monitoring framework and indicators (84). In 2015, the global community reaffirmed its commitment to sustainable development by endorsing the 2030 Agenda for Sustainable Development and its 17 Sustainable Development Goals. To reach older people – an important, heterogeneous and growing population – and to create visibility in global and national policy and accountability mechanisms, a closer examination is needed of the various data collection mechanisms and methods available, and the types of data collected to measure each SDG indicator relevant for older people, including existing levels of disaggregation, analysis and dissemination. The report provides concrete examples of indicators and learnings from 20 national statistics offices on SDG indicators relevant for older people that are already being collected. Shared experiences from around the world demonstrate that disaggregation of data is possible, and that this information is useful to indicate the diverse experiences of older persons. Making older persons visible in the Sustainable Development Goals’ monitoring framework and indicators Introduction 1 Framework 2 Indicators 3 Gaps 4 References Glossary 6 7 535. Best practices for strengthening monitoring and evaluation systems in countries Best practices5 5.5 Using M&E findings to guide action Effectively using M&E findings is crucial for driving evidence-based decisions and actions that support healthy ageing. M&E data should inform policies, programmes and interventions, ensuring they are responsive to the needs of older populations. By leveraging M&E insights, stakeholders can enhance transparency, accountability and advocacy, creating a positive impact on the lives of older adults. Good practice recommendations i. Disseminate data effectively • Accessible communication. Ensure that M&E findings are presented in formats that are easily understandable by all stakeholders, including policy-makers, health care providers, and the public. Develop a user-friendly dashboard that allows stakeholders to interact with data and explore key findings (see Box 13). For example, create a dashboard that shows trends in health care access among older people, with interactive elements that allow users to filter by region or demographic group. • Tailored messaging. Customize communication strategies to different audiences, ensuring that key messages resonate with the specific needs and interests of each group. For policy- makers, focus on policy implications and data that support decision-making. For health care providers, highlight clinical outcomes and service delivery improvements. For the public, emphasize the impact of healthy ageing initiatives on community well-being. Tailor content for each audience by developing separate reports, presentations or briefings that focus on their specific concerns. • Multi-channel dissemination. Utilize multiple dissemination channels – such as social media, websites, community meetings and newsletters – to reach a broad audience and ensure widespread access to M&E findings. Create a social media campaign that shares key M&E insights using short, impactful posts and infographics. Organize community meetings where findings are presented and discussed in person, ensuring that those who may not have access to digital platforms can still engage with the data. Additionally, distribute newsletters that summarize findings and provide actionable steps for community members, health care providers and policy-makers. ii. Promote evidence-based decision-making • Embed data in policy processes. Ensure that M&E data are systematically integrated into decision-making at all levels. Work with government agencies and health care institutions to establish processes that require the use of M&E data when planning and evaluating interventions. Create concise policy briefs and actionable recommendations based on M&E data, and actively present them in decision-making forums. Organize workshops or briefings where data analysts can directly communicate findings to policy-makers and programme developers, ensuring that data insights are aligned with policy goals. • Incentivize evidence use. Establish mechanisms that reward the use of empirical data in policy formulation, such as linking funding allocations to evidence-based practices. Advocate for policies that tie funding or other resources to the demonstration of data- driven decision-making. Develop guidelines that clearly outline how M&E data should be used in policy development and propose financial incentives for programmes that Introduction1 Framework2 Indicators3 Gaps4 References Glossary 6 7 54 Measuring the progress and impact of the UN Decade of Healthy Ageing (2021–2030) Best practices 5 effectively integrate data into their planning processes. For example, set up a grant programme that awards additional funds to local governments or organizations that can demonstrate how they used M&E data to create age-friendly community initiatives. • Decision-making frameworks. Collaborate with policy-makers to design decision-making frameworks that incorporate M&E data, ensuring a structured approach to evidence- based policy-making. Work with policy experts and data analysts to develop frameworks that guide decision-makers on how to systematically use M&E data in their work. These frameworks should outline steps for evaluating data, prioritizing interventions, and allocating resources based on evidence. Provide training sessions for policy-makers and programme managers on how to apply these frameworks and offer ongoing support to ensure that data is effectively integrated into decision-making processes. iii. Make data accessible and transparent • Public reporting. Regularly publish M&E findings in the public domain to foster transparency and accountability. Create a dedicated online portal where all M&E data, reports and updates can be easily accessed by the public and stakeholders. This portal should be regularly updated with new findings and should include options for downloading data in multiple formats. Additionally, ensure that the portal is user-friendly and accessible to a broad audience, including non-technical users. Promote the portal through social media, newsletters and community outreach to maximize awareness and usage (see Box 13). • Interactive dashboards. Develop interactive dashboards that allow stakeholders to explore data trends and track progress toward healthy ageing goals. Invest in user-friendly data visualization tools that allow stakeholders to interact with M&E data in real time (85). These dashboards should be intuitive and customizable, enabling users to filter data by region, age group, or specific indicators. Offer training sessions or tutorials on how to use the dashboards effectively, ensuring that all stakeholders can engage with the data. Regularly solicit feedback from users to improve the functionality and usability of the dashboards. • Regular updates. Ensure that data and progress reports are consistently updated to reflect the latest developments and maintain stakeholder engagement. Establish a clear reporting schedule, with quarterly, bi-annual or annual updates, depending on the nature of the data. Communicate this schedule to stakeholders so they know when to expect new information. Additionally, set up automated systems that notify users of new updates or reports, either via email or through notifications on the data portal. This approach helps maintain transparency and keeps stakeholders engaged with the ongoing progress of healthy ageing initiatives. iv. Engage the public in advocacy and action • Public engagement and advocacy. Empower older people and their advocates with M&E data to engage in advocacy efforts to influence policy, promote age-friendly environments, and advance the rights and priorities of older populations. Use compelling data-driven narratives to mobilize support and drive systemic change (86). • Community mobilization and advocacy campaigns. Use compelling data narratives to mobilize community support for healthy ageing initiatives and to drive advocacy efforts. Leverage M&E data to raise awareness, inspire action and push for policy changes, age- friendly environments, and the protection of older persons’ rights. Develop community outreach programmes that integrate M&E data to raise awareness and collaborate Introduction 1 Framework 2 Indicators 3 Gaps 4 References Glossary 6 7 555. Best practices for strengthening monitoring and evaluation systems in countries Best practices5 with advocacy organizations to launch campaigns. These campaigns should highlight key findings and promote policy reforms that address the needs and rights of older populations. • Learning and knowledge sharing. Promote a learning and knowledge-sharing culture by documenting M&E processes, lessons learned and successful case studies. Disseminate findings through conferences, publications and online platforms to contribute to global knowledge on effective practices in promoting healthy ageing. Box 13. Bringing data to life: A case study of the ProfiBaza portal launched by the Poland Ministry of Health Launched in late 2021, the ProfiBaza portal is an on-line repository that provides decision-makers with easy access to a knowledge base (e.g. reports, guides etc.), as well as data on public health interventions (87). The inspiration for the portal arose five years prior to its launch, in 2016. AT the time, information about implemented health programmes remained scattered and essentially unavailable in Poland via open access. Developing the portal involved collecting information about ongoing public health interventions and practices, summarizing them in one place, and making the corresponding data available to a wide audience. The ProfiBaza system comprises two sections, each tailored for specific users/ audiences: one for the public and another for institutions reporting on public health indicators and progress. The system includes a register of public health interventions (i.e. in the areas of health promotion and disease prevention) and statistical reports, as well as a knowledge base for researchers, practitioners in the field of public health and anyone interested in health situation and its determinants. The main objectives of the portal are to: a. assist the planning, implementation and evaluation of public health interventions in Poland, as well as promoting multisectoral collaboration in health and addressing social inequalities in health; b. building a platform for knowledge translation (i.e. adapting evidence into practice) as part of the ProfiBaza system; c. improving the quality of public health interventions implemented in different settings as well as the quality of collected data on health promotion interventions carried out in Poland. The ProfiBaza portal offers a broad range of information to inform epidemio- logical surveillance, health promotion and disease prevention practices, including for different settings (e.g. schools, communities), target groups (e.g. children, older people, socially disadvantaged groups), and health topics (e.g. mental health, nutrition, health policy). Introduction1 Framework2 Indicators3 Gaps4 References Glossary 6 7 56 Measuring the progress and impact of the UN Decade of Healthy Ageing (2021–2030) Best practices 5 5.6. Summary Building a strong national M&E system for the UN Decade of Healthy Ageing requires sustained collaborative efforts and adaptive practices. Central to this process is the prioritization of strategic reviews and alignment, to ensure that the M&E system remains relevant and effective over time. Developing a responsive underlying theory of change is crucial, as it provides a coherent framework for understanding how interventions are expected to achieve desired outcomes. This theoretical foundation is essential for constructing an integrated M&E framework that connects real-world resources, activities and results in a logical sequence. Moreover, the establishment of clear baselines and targets is vital for measuring progress and assessing the impact of various initiatives. Accurate baseline data serves as a reference point against which future progress can be measured, while well-defined targets provide clear objectives for what the strategy aims to achieve. Improving population-level data collection and analysis enhances the ability to track trends and identify emerging needs within the ageing population. Fostering meaningful policy dialogues is another key component, as it ensures that stakeholder perspectives are incorporated into the decision-making process. This engagement not only promotes transparency and accountability but also strengthens the relevance of an M&E system in addressing the specific needs of older people. Embracing a culture of continuous improvement is essential for refining and adapting indicators in response to new evidence and evolving contexts. Implementing the best practices recommended in this document enables countries to align their monitoring initiatives with the global measurement framework of the UN Decade of Healthy Ageing. Robust national monitoring and evaluation systems are not only vital for overseeing national action plans but are even more critical for supporting regional and global efforts on healthy ageing. By aligning measurement frameworks, indicators and data collection efforts, countries can promote standardization, thereby improving the quality and reliability of data. This global alignment is essential for creating a cohesive approach to healthy ageing, allowing nations to collectively address challenges, share best practices, and enhance the effectiveness of interventions worldwide. Introduction 1 Framework 2 Indicators 3 Gaps 4 References Glossary 6 7 575. Best practices for strengthening monitoring and evaluation systems in countries 6. 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References Locals enjoy spending time in the shade of traditional huts, Bali, Indonesia. ©Unsplash 7Glossary 7. Glossary of terms The terms included in this glossary consist mainly of those that are relevant for monitoring and evaluation, aiming to enhance clarity and understanding of key concepts that are central to the current framework. The glossary contains core definitions of each term, with specific sources cited, and where possible a web link is provided to facilitate access to source documents. Ability to be mobile Mobility is defined by WHO as movement in all its forms, whether powered by the body (with or without an assistive device) or a vehicle (1). Ability to be mobile refers to the movement of a person within their environment, extending from their home to the community and beyond. Ability to build and maintain relationships The abilities to build and maintain relationships and social networks refer to a range of competencies, including the abilities to form new relationships and behave in ways that are socially appropriate (1). These include social relations with children and other family members, intimate partners, friends, neighbours, colleagues and acquaintances; as well as formal relationships with community-service providers. Ability to contribute The ability to contribute covers the myriad contributions that older people make to their families and communities, such as assisting friends and neighbours, mentoring peers and younger people, and caring for family members and the wider community (1). Ability to learn, grow and make decisions Abilities to learn, grow and make decisions include efforts to continue to: learn and apply knowledge, engage in problem solving, continue personal development and making choices (1). Ability to meet basic needs Ability to meet basic needs includes older people being able to afford: an adequate diet, clothing, suitable housing, health care, long-term care services (1). It also extends to having support to minimize the impact of economic shocks that may come with illness, disability, losing a spouse or the means of livelihood. Accuracy of data The proximity of the result of an indicator to the exact or true value (2). Accurate statistics are those that capture the phenomena being measured and do so in repeated measurements. Accuracy requires proper concern for consistency across geographic areas, across time and for statistical measures of errors in the data. Administrative data Administrative data are data collected by government institutions as part of their routine operations (including private sector data such as insurance claims for treatment) (3). Information primarily collected for the purpose of record-keeping, which is subsequently used to produce statistics. Some examples include data from registrars, hospital morbidity data etc. Introduction 1 Framework 2 Indicators 3 Gaps 4 Best practices 5 References 6 657. Glossary of terms Glossary7 Age Age is the time lived since birth (1). Although correlated with biological processes, age is also socially and culturally shaped. Age-friendly environments An environment (e.g. home or community) that fosters healthy, active ageing by building and maintaining intrinsic capacity throughout the life-course and enabling greater functional ability in someone with a given level of capacity (1). Age groups The combining of ages into groups for the purpose of data analysis. These groupings usually capture a time interval representing a developmental stage in the life course of a human. The actual aggregation used depends on the purpose of the analysis and the sample size (2). WHO proposes age groups for analysis of older persons data as follows; 60–64 years, 65–69 years, 70–74 years, 75–79 years, 80–84 years, 85–89 years, 90–94 years, 95–99 years and 100+ years. Ageing Ageing is the process of becoming older and represents the accumulation of changes over time, encompassing physical, psychological and social changes. The changes that constitute and influence ageing are complex. At a biological level, ageing is associated with the gradual accumulation of a wide variety of molecular and cellular damage (1). Over time, this damage leads to a gradual decrease in physiological reserves, an increased risk of many diseases and a general decline in the capacity of the individual. Ultimately, it results in death. Ageism Ageism refers to the stereotypes, prejudice and discrimination directed towards others or oneself based on age (1). Assistive devices Assistive device (or assistive health technology) refers to any device designed, made or adapted to help a person perform a particular task; products may be generally available or specially designed for people with specific losses of capacity; assistive health technology is a subset of assistive technologies, the primary purpose of which is to maintain or improve an individual’s functioning and well-being (1). Avoidable mortality Avoidable mortality, comprising both preventable and treatable (amenable) mortality: • Preventable mortality: Causes of death that can be mainly avoided through effective public health and primary prevention interventions (i.e. before the onset of diseases/injuries, to reduce incidence). • Treatable (or amenable) mortality: Causes of death that can be mainly avoided through timely and effective health care interventions, including secondary prevention and treatment (i.e. after the onset of diseases, to reduce case fatality). Introduction1 Framework2 Indicators3 Gaps4 Best practices5 References6 66 Measuring the progress and impact of the UN Decade of Healthy Ageing (2021–2030) 7Glossary Campaign Campaign refers to purposive attempts to inform or influence behaviours in large audiences within a specified period by using an organized set of communication activities and featuring an array of mediated messages delivered through multiple channels to produce non- commercial benefits to individuals and society (4). Capacity building The development of knowledge, skills, commitment, partnerships, structures, systems and leadership to enable effective health promotion actions (5). The initiative aims to accelerate the adoption and scale up of interventions or programmes or solutions and serves as a platform to share best practices and lessons learned. Care dependence Care dependence arises when an individual’s functional ability has fallen to a point where they are no longer able to undertake the basic tasks that are necessary for daily life without the assistance of others (1). Caregiver A caregiver is a person who provides care and support to someone else; such support may include: a) helping with self-care, household tasks, mobility, social participation and meaningful activities; b) offering information, advice and emotional support, as well as engaging in advocacy, providing support for decision making and peer support, and helping with advance care planning; offering respite services; and c) engaging in activities to foster intrinsic capacity. Caregivers may include family members, friends, neighbours, volunteers, care workers and health professionals (1). Chronosystem A component of Urie Bronfenbrenner’s ecological systems theory (6). The chronosystem refers to environmental changes and transitions for an individual over time. Cognitive capacity Cognitive capacity refers to an individual’s mental capacity and spans a large spectrum of cognitive domains, encompassing memory, attention, executive function, perception, visuo- construction, orientation and language abilities (1). Cognitive impairment Cognitive impairment: A loss or abnormality in attention functions, memory functions or higher-level cognitive functions: a) Attention functions are mental functions that focus on an external stimulus or internal experience for a specific period of time; b) memory functions are mental functions that register and store information and retrieve it as needed; c) higher- level cognitive functions, often called executive functions, are mental functions that involve the frontal lobes of the brain (7). They include complex goal-directed behaviours such as decision-making, abstract thinking, making and carrying out plans, mental flexibility and deciding which behaviours are appropriate under specific circumstances. Community health worker Individuals who provide health education, referral and follow up, case management, and basic preventive health care and home visiting services to specific communities (7). They provide support and assistance to individuals and families in navigating the health and social services system. Introduction 1 Framework 2 Indicators 3 Gaps 4 Best practices 5 References 6 677. Glossary of terms Glossary7 Comprehensive health and social care assessment Comprehensive health and social care assessment a multidimensional assessment of an older person that includes medical, physical, cognitive, social and spiritual components; may also include the use of standardized assessment instruments and an interdisciplinary team to support the process (1). Concurrent validity Concurrent validity is one approach of criterion validity that estimates individual performance on different tests at approximately the same time (8). Construct validity The degree to which a measurement aligns with related theoretical hypotheses, demonstrating that it accurately represents the underlying theoretical concept. It indicates how well the scores reflect the intended construct, ensuring the results are meaningful and relevant. Construct validity is commonly applied to process indicators (2). Continuum of care The spectrum of personal and population health care required at all stages of a condition, injury or event throughout life, including health promotion, disease prevention, diagnosis, treatment, rehabilitation and palliative care (9). Convergent validity How closely the indicator is related to other variables and other measures of the same construct. This approach is utilized when a gold standard does not exist. Convergent validity is often used for impact indicators (2). Correlation analysis Examination of the strength and direction of linear relationships between two continuous variables (2). Criterion validity The extent to which the measurement correlates with an external criterion of the phenomenon under study; ideally, a gold standard (2). Cross-sectional survey A survey that examines the relationship between diseases (or other health outcomes) and other variables of interest as they exist in a defined population at one particular time (10). The presence or absence of disease and the presence or absence of other variables (or, if they are quantitative, their level) are determined in each member of the study population or in a representative sample at one particular time. The relationship between a variable and the outcome can be examined: a) in terms of the prevalence of the outcome in different population subgroups defined according to the presence or absence (or level) of the variables; and/or b) in terms of the presence or absence (or level) of the variables in the individuals with and without the outcome. Data accessibility The ease with which users can find, retrieve, understand, and use data (2). Introduction1 Framework2 Indicators3 Gaps4 Best practices5 References6 68 Measuring the progress and impact of the UN Decade of Healthy Ageing (2021–2030) 7Glossary Data custodian Agencies or individuals responsible for managing the use, disclosure and protection of source data used to create health indicators. Data custodians collect and hold information on behalf of a data provider or data steward (2). Data–information pyramid A schematic way of looking at the number of data items to be collected at each level of the health system allowing each level to gather data of importance and relevance to their daily work while avoiding excessive data where no action is taken (2). The pyramid illustrates how most data are collected at the base of the pyramid in the health facility, where most health service action takes place. Data are processed, filtered and streamlined as data sets are passed up the health system. Data provider Individuals and organizations who are responsible, whether formally or informally, for making data accessible to others. Sometimes a data provider may be simply the producer of those data. In other cases, data may be deposited in a repository, centre or archive that has the responsibility of disseminating the data (2). Data quality assessment The analysis or evaluation of data to determine its accuracy, completeness, consistency, and other quality attributes based on predefined criteria. This process helps identify issues and areas for improvement in the current state of data quality (2). Data triangulation The analysis of data from three or more sources obtained by different methods (2). Findings can be corroborated, and the weakness or bias of any of the methods or data sources can be compensated for by the strengths of another, thereby increasing the validity and reliability of the results. Denominator The lower portion of a fraction; that is the number below the horizontal bar of a fraction. It is used to calculate, for example, rates, ratios and percentages. In a rate, the denominator is usually the population (or population experience, as in person-years, etc.) at risk. Discrimination Discrimination consists of any actions, practices, laws or policies that are applied to people based on their perceived or real membership in a socially salient group and that impose some form of direct or indirect disadvantage (negative discrimination) or advantage (positive discrimination) on them (4). In the case of age-based discrimination, these actions, practices and policies are directed at people perceived to belong to a specific age group. Ecological systems theory A theory developed by Urie Bronfenbrenner to describe how a person’s development throughout the lifespan may be affected by their environment and interactions within it (6). Introduction 1 Framework 2 Indicators 3 Gaps 4 Best practices 5 References 6 697. Glossary of terms Glossary7 Elder abuse Elder abuse is a single or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust that causes harm or distress to an older person (1). Enabling environments Environments comprise all the factors in the extrinsic world that form the context of an individual’s life (1). These include – from the micro- to the macro-level – home, communities and the broader society. Within these environments are a range of factors, including the built environment, people and their relationships, attitudes and values, health and social policies, the systems that support them, and the services that they implement. Environmental worker An environmental worker, also known as sanitation workers, is a professional who performs cleaning and sanitation tasks in an organization to maintain clean and sanitary environments for workers and visitors (11). They handle duties such as mopping, sweeping and disinfecting surfaces to ensure a safe and hygienic workplace. Exosystem The exosystem is a component of Urie Bronfenbrenner’s Ecological Systems Theory (6). It refers to the indirect environment that may affect a person’s development throughout the lifespan (e.g. wider social, economic, environmental, or political factors). External consistency of data An assessment of the level of agreement between two sources of data measuring the same health indicator (2). The two sources of data that are usually compared are data flowing through a health information system (or programme-specific information system) and data from periodic population-based surveys. External responsiveness Reflects the extent to which change in a measure relates to corresponding change in a reference measure of clinical or health status (2). Fall A fall is an event which results in a person coming to rest inadvertently on the ground or floor or other lower level (7). Falls, trips and slips can occur on one level or from a height. This definition of a fall includes syncopal events. Forgone care Forgone health or social care, defined as not using care services despite perceiving a need for it due to cost, distance or social cultural factors (12). Formal long-term care workers Formal long-term care workers include the following occupations and categories (13): a) Nurses, as defined by the ISCO-08 classification (2221 ISCO code for professional nurses and 3221 ISCO code for associate professional nurses, providing long-term care at home or in LTC institutions (other than hospitals)); b) personal care workers (caregivers) include formal workers providing long-term care services at home or in institutions (other than hospitals) and who are not qualified or certified as nurses. As per the draft definition in the ISCO-08 Introduction1 Framework2 Indicators3 Gaps4 Best practices5 References6 70 Measuring the progress and impact of the UN Decade of Healthy Ageing (2021–2030) 7Glossary classification, personal care workers are defined as people providing routine personal care, such as bathing, dressing or grooming, to elderly, convalescent, or disabled persons in their own homes or in institutions. Fragility fracture Fragility fractures are fractures that result from mechanical forces that would not ordinarily result in fracture, known as low-level (or ‘low energy’) trauma (14). The WHO has quantified this as forces equivalent to a fall from a standing height or less. Functional ability Functional ability comprises the health-related attributes that enable people to be and to do what they have reason to value (1). It is made up of the intrinsic capacity of the individual, relevant environmental characteristics and the interactions between the individual and these characteristics. Geriatric care Geriatric care is multidisciplinary team approach to caring for older people and supporting family caregivers, including close friends (15). The geriatrics care team may include geriatricians, geriatric (or gerontological) nurse practitioners, physician assistants, social workers, consultant pharmacists, dietitians, physical therapists, occupational therapists, speech and hearing specialists, psychiatrists and psychologists. Geriatrician Geriatricians are doctors with special training in evaluating and managing older people’ health care needs and treatment (16). These doctors are board-certified internists or family physicians who have additional training and certification in geriatrics. Geriatricians often care for frail and medically complex older people in multiple settings, including acute or hospital care, sub-acute rehabilitation, long-term care, assisted living facilities, ambulatory (office) settings, or at a patient’s home. Health care-associated infection Health care-associated infections (HAIs) are infections people get while they are receiving health care for another condition. HAIs can happen in any health care facility, including hospitals, ambulatory surgical centres, end-stage renal disease facilities, and long-term care facilities (17). Health impact assessment Health impact assessment is a combination of procedures, methods and tools by which a policy, programme, product or service may be judged concerning its effects on the health of the population and the distribution of those effects within the population (2). Health indicator A measurable quantity that can be used to describe a population’s health or its determinants (2). Indicators can be categorized into four domain such as health status (e.g. life expectancy, healthy life expectancy, prevalence of diseases), risk factors (e.g. insufficient physical activity, prevalence of falls), service coverage (e.g. cataract surgery, long-term care coverage rate), or health systems (e.g. long-term care bed density, number of geriatricians). Introduction 1 Framework 2 Indicators 3 Gaps 4 Best practices 5 References 6 717. Glossary of terms Glossary7 Health information system A system that collects data from health and other relevant sectors, analyses the data and ensures their overall quality, relevance and timeliness, and converts the data into information for health-related decision-making. It has four key functions: (i) data generation; (ii) compilation; (iii) analysis and synthesis; and (iv) communication and use. A solid health information system will be capable of generating reliable data from hospitals, outpatients, reportable diseases registries, surveys, civil registration and vital statistics and other relevant data for health (2). Health system A health system is the aggregate of all public and private organizations, institutions and resources mandated to improve, maintain or restore health (18). This includes both personal and pop ulation services, as well as activities to influence the policies and actions of other sectors to address the political, social, environmental and economic determinants of health. Healthy ageing The process of developing and maintaining the functional ability that enables wellbeing in older age (1). Healthy life expectancy at age 60 The average number of years in full health a person (usually at age 60) can expect to live based on current rates of ill-health and mortality (19). Hearing loss or impairment Loss or abnormality in sensory functions relating to perception of the presence of sounds or discriminating the location, pitch, loudness or quality of sounds (7). Human rights Human rights are the rights people are entitled to simply because they are human beings, irrespective of their age, citizenship, nationality, race, ethnicity, language, gender, sexuality or abilities (4). When these inherent rights are respected, people can live with dignity and equality, free from discrimination. The concept of human rights has its origins in a wide range of philosophical, moral, religious and political traditions, and it has evolved over time. Informal care Informal care is unpaid care provided by a family member, friend, neighbour or volunteer (1). Impact indicator Measures the ultimate objective that programmes are designed to affect, such as decreases in mortality and morbidity. Sometimes this is referred to as a long-term outcome (2). Input indicator Measures human and financial resources, physical facilities, equipment and operational policies that enable programme activities to be implemented. This includes health financing, health workforce, health infrastructure, and health information and governance (2). Introduction1 Framework2 Indicators3 Gaps4 Best practices5 References6 72 Measuring the progress and impact of the UN Decade of Healthy Ageing (2021–2030) 7Glossary Institutional ageism Institutional ageism refers to the laws, rules, norms, policies and practices of institutions – and the ideologies that are fostered to justify them – that unfairly restrict opportunities and systematically disadvantage individuals based on their age (4). Institutional care setting Refers to institutions in which long-term care is provided; these may include community centres, assisted living facilities, nursing homes, hospitals and other health facilities; institutional care settings are not defined only by their size (1). Insufficient physical activity Insufficient physical activity is defined as population attaining less than 150 minutes of moderate-intensity physical activity per week, or less than 75 minutes of vigorous-intensity physical activity per week, or equivalent (20). Integrated health services Integrated health services are managed and delivered in a way that ensures people receive a continuum of services including health promotion, disease prevention, diagnosis, treatment, disease-management, rehabilitation and palliative care at different levels and sites within the health system, and that care is provided according to their needs throughout their life course (1). Integrity of data Data have integrity when the system used to generate them is protected from deliberate bias or manipulation for political or personal reasons (21). Intergenerational intervention Intergenerational contact activities and interventions aim to foster interaction and contact between people of different generations or age groups, often to reduce ageism (4). They can either involve direct contact through face-to-face interactions or indirect contact through, for instance, virtual conversations or imagined contact. Internal consistency of data Measures human and financial resources, physical facilities, equipment and operational policies that enable programme activities to be implemented. This includes health financing, health workforce, health infrastructure, and health information and governance. Internal responsiveness Characterizes the ability of a measure to change over a pre-specified time frame (2). Interpersonal ageism Interpersonal ageism refers to ageism occurring during interactions between two or more individuals (4). In interpersonal ageism, the perpetrator is distinguished from the target of ageism. Intrinsic capacity Intrinsic capacity is the composite of all the physical and mental capacities of an individual. These include, cognitive capacity, psychological capacity, sensory capacity, vitality capacity and locomotor capacity. Introduction 1 Framework 2 Indicators 3 Gaps 4 Best practices 5 References 6 737. Glossary of terms Glossary7 Law Law is the system of rules that a particular country or community recognizes as regulating the actions of its members and that may be enforced by imposing penalties (4). It includes international law and national law. International law defines the legal responsibilities of states in their conduct with each other and their treatment of individuals within state boundaries. National law or domestic law refers to those laws that exist within a particular country. Life expectancy at age 60 Life expectancy (at age 60) is the average number of years that a 60 year-old can expect to live if he or she is subject to the age-specific mortality rate during a given period (1). Locomotor capacity Locomotor capacity is a state (static or dynamic over time) of the musculoskeletal system that encompasses endurance, balance, muscle strength, muscle function, muscle power and a joint function of the body, proposed by WHO working group (22). Longitudinal survey Longitudinal survey is an analytic epidemiological study in which subsets of a defined population can be identified who are, have been, or in the future may be exposed or not exposed – or exposed in different degrees – to a factor or factors hypothesized to influence the occurrence of a given outcome. It administers repeated measurements to collect data from the same sample units over time to measure gross change (i.e. change at the level of individual sample members) (10). Long-term care Long-term care refers to the activities undertaken by others to ensure that people with a significant ongoing loss of intrinsic capacity can maintain a level of functional ability consistent with their basic rights, fundamental freedoms and human dignity (1). Long-term care facilities Long-term care facilities refer to the varied settings in which people may receive long-term care (9). This may include home care, community-based care, residential care, or hospital care. Malnutrition Malnutrition refers to deficiencies or excesses in nutrient intake, imbalance of essential nutrients or impaired nutrient utilization (7). Measurement level The specific setting that the indicator is designed to measure/monitor (e.g. national, subnational, facility, or community) (2). Metadata Data that define or describe other data (2). They are the information needed to explain and understand the data or values being presented. Mild cognitive impairment A disorder characterized by memory impairment, learning difficulties and reduced ability to concentrate on a task for more than brief periods (7). There is often a marked feeling of mental Introduction1 Framework2 Indicators3 Gaps4 Best practices5 References6 74 Measuring the progress and impact of the UN Decade of Healthy Ageing (2021–2030) 7Glossary fatigue when mental tasks are attempted, and new learning is found to be subjectively difficult even when objectively successful. None of these symptoms is so severe that a diagnosis of either dementia or delirium can be made. Monitoring and evaluation (M&E) framework A structured and systematic tool used in project management and programme implementation to assess performance, measure outcomes, and ensure the achievement of objectives. It consists of several core components, including clear project objectives, key performance indicators, data collection methods, data sources, and responsibilities. It defines how data will be collected, analysed and reported, ensuring that the project or programme remains on track (2). Multi-stakeholder forum Consists of a diverse set of stakeholders – both government and non-governmental – including older persons and their family caregivers, that documents need and expectation, and facilitates the exchange of information, good practice and tools across sectors and different actors (23). National focal point National focal points are the national experts in the healthy ageing programmes of WHO Member States appointed by the national governments (24). National healthy ageing strategy and action plan Strategic plans designed by governments to guide action to promote healthy ageing, and the allocation of related resources, over a specified period of time and towards the fulfilment of national commitments and goals. With respect to healthy ageing, national action plans are typically developed to guide the implementation of following actions: combating ageism, fostering age-friendly communities, integrated primary health care and long-term care for older people (24). Older person A person aged 60 years or older (1). Out-of-pocket expenditure Payments for goods or services that include: a) Direct payments, such as payments for goods or services that are not covered by any form of insurance; b) cost sharing – a provision of health insurance or third-party payment scheme that requires the individual who is covered to pay part of the cost of the health care received; and c) informal payments, such as unofficial payments for goods and services, that should be fully funded from pooled revenue (1). Outcome indicator Measures whether a given programme is achieving the expected effects/changes in the short, intermediate and long term (2). Some programmes refer to their longest-term/most distal outcome indicators as impact indicators. Outdoor environment Outdoor environment includes neighbourhood walkability, accessibility of public space and feelings of safety (25). Introduction 1 Framework 2 Indicators 3 Gaps 4 Best practices 5 References 6 757. Glossary of terms Glossary7 Output indicator Measures the immediate products provided or services delivered as a result of the processes conducted in a programme or project, such as number of persons trained, number of older persons vaccinated (2). Palliative care Palliative care aims to prevent and relieve health-related suffering of adults, children and their families facing problems associated with life-threatening illness (26). Policies Policies refer to decisions, plans and actions that are undertaken to achieve specific goals within a society (4). Health policy refers to decisions, plans and actions that are undertaken to achieve specific health care goals within a society. An explicit health policy can achieve several things: it defines a vision for the future, which in turn helps to establish targets and points of reference for the short and medium term. It outlines priorities and the expected roles of different groups, and it builds consensus and informs people. Process indicator Measures a programme’s activities. This indicates whether the programme is being implemented as planned (e.g. health workforce training, constructing a health facility) (2). Programme A coordinated and comprehensive set of planned, sequential strategies, activities and services designed to achieve well-defined objectives and targets (28). A national programme usually has national, subnational and local coordinators, and dedicated funding to support planned activities. Within the health sector the term ‘national health programme’ is often used to indicate national health system components that administer specific services (e.g. integrated care for older persons, long-term care for older persons). In a broader sense, age- friendly communities initiatives can also be considered as programmes. Psychological capacity Psychological capacity refers to resilience, positive beliefs, thoughts, mood and feelings that enable individuals to enhance their physical, mental and social functioning (21). Record linkage The methodology of bringing together corresponding records from two or more files or finding duplicates within files (2). Rehabilitation Rehabilitation is a set of measures aimed at individuals who have experienced or are likely to experience disability to assist them in achieving and maintaining optimal functioning when interacting with their environments (1). Relevance of data The degree to which the data meet the user needs (2). Indicators must provide information that is appropriate and useful for guiding policies and programmes as well as for decision-making. Introduction1 Framework2 Indicators3 Gaps4 Best practices5 References6 76 Measuring the progress and impact of the UN Decade of Healthy Ageing (2021–2030) 7Glossary Reliability of data The degree to which the results obtained by a measurement/procedure can be replicated. Consistency of the data when collected repeatedly using the same procedures and under the same circumstances [synonym: replicability] (2). Risk factor Risk factor is an attribute or exposure that is causally associated with an increased probability of a disease or injury (1). Routine health information systems A system that generates data collected at public and private health facilities and institutions, and at community-level health care posts and clinics – at regular intervals of a year at minimum. The data give a picture of health status, health services and health resources. Most of the data are gathered by health care providers, by supervisors and through routine health facility surveys. The sources of those data are generally individual health records, records of services delivered, and resource health records including financial, commodity or laboratory records (2). Secondary data sources Data that was originally collected for other purposes. The data from these existing sources are considered secondary. Although these data were not created for the purpose at hand, they facilitate the development of the required indicators. Data from a census, research, information system, etc. are secondary data (2). Self-directed ageism Self-directed ageism refers to ageism turned against oneself (4). People internalize biases based on age from the surrounding culture after being repeatedly exposed to them, and they then apply the biases to themselves Sensitivity analysis A systematic approach to evaluate how the variation in the output of a system or model can be attributed to different sources of variation in its inputs. It involves examining the sensitivity of the model’s outcomes or outputs to changes in individual input parameters, providing insights into the relative importance of each parameter in influencing the overall results (2). Sensory capacity Sensory capacity refers to functions of sensory system: vision, hearing, touch, taste and smell (22). Social care Social care (services) offer assistance with the activities of daily living (such as personal care, maintaining the home etc.) (1). Social protection Social protection programmes aim to reduce deprivation that arises from conditions such as poverty, unemployment, old age and disability (1). Statistical methods Various techniques employed in data analysis for validation of studies and results (29). Introduction 1 Framework 2 Indicators 3 Gaps 4 Best practices 5 References 6 777. Glossary of terms Glossary7 Surveillance The continuous, systematic collection, analysis, interpretation, and dissemination of data needed for the planning, implementation and evaluation of public health actions. Some examples are public health surveillance system, indicator-based surveillance, disease surveillance system, demographic surveillance system, etc. (2). Survey data A survey is an investigation about the characteristics of a given population by means of collecting data from a sample of that population and estimating their characteristics through the systematic use of statistical methodology (2). Target population A population about which information is wanted and estimates are required. It can be a group of individuals who meet specific criteria for inclusion in a survey. In relation to health care, it is often a group of individuals in need of a specific intervention or service (2). Theory of change A theory of change is a structured approach used in the design and evaluation of public health programmes to explore change and how it happens (30). It maps the logical chain of how programme inputs achieve changes in outcomes. Timeliness of data When the data is quickly available and accessible for use. In the context of data quality, the degree to which reports are submitted on time according to established deadlines. Timeliness involves the availability and reliability of the data at the time it is needed to construct related indicators. Thus, timely indicators provide better opportunities for making health-related decisions (2). Universal health coverage Universal health coverage means that all people have access to the health services they need, at high quality, when and where they need them, without financial hardship across the life course (5). It includes the full range of essential health services, from health promotion to prevention, treatment, rehabilitation and palliative care. Unmet health care needs The presence of health care needs for which people do not or cannot receive quality health care services (31). Unmet social care needs The presence of social care needs for which people do not or cannot receive quality care services (32). Urinary incontinence Involuntary leakage of urine (7). The majority of causes can be divided into three types: a) urge incontinence: involuntary leakage of urine associated with, or immediately following, a sudden compelling need to void; b) stress incontinence: involuntary leakage when performing physical activity, coughing or sneezing; and c) mixed urinary incontinence: a combination of urge incontinence and stress incontinence. Introduction1 Framework2 Indicators3 Gaps4 Best practices5 References6 78 Measuring the progress and impact of the UN Decade of Healthy Ageing (2021–2030) 7Glossary Validity Ability of an indicator to measure what it is intended to measure (i.e. absence of distortions, bias or systematic errors). The most relevant biases are those related to selection of the study population and the quality of the information compiled (2). Visual impairment A loss or abnormality in sensory functions relating to the perception of the presence of light or to sensing the form, size, shape or colour of the visual stimuli (7). Vitality capacity Vitality capacity is a physiological state (due to normal or accelerated biological ageing processes) resulting from the interaction between multiple physiological systems, reflected in (the level of) energy and metabolism, neuromuscular function, and immune and stress response functions of the body (22). Well-being Well-being refers to the total universe of human life domains, including the physical, mental and social aspects that make up what can be called a ‘good life’ (1). It includes domains such as happiness, satisfaction and fulfilment. Well-being may be measured subjectively or objectively. Introduction 1 Framework 2 Indicators 3 Gaps 4 Best practices 5 References 6 797. Glossary of terms Glossary7 Glossary references 1. World report on ageing and health. Geneva: World Health Organization; 2015 (https://iris.who. int/handle/10665/186463). 2. Glossary of health data, statistics, and public health indicators. Geneva: World Health Organization, (https://cdn.who.int/media/docs/default-source/documents/ddi/ indicatorworkinggroup/glossary_of_terms_june-2024.pdf?sfvrsn=ac699779_1). 3. Toolkit for quality assessment of administrative data for official statistics. Nairobi: UN Women East and Southern Africa Regional Office; 2022 (https://data.unwomen.org/publications/ toolkit-quality-assessment-administrative-data-official-statistics, accessed 21 October 2024). 4. Global report on ageism. Geneva: World Health Organization; 2021 (https://iris.who.int/ handle/10665/340208). 5. Health promotion glossary of terms 2021. Geneva: World Health Organization; 2021 (https:// iris.who.int/handle/10665/350161). 6. Bronfenbrenner U. Toward an experimental ecology of human development. American Psychologist. 1977;32(7):513–531. 7. Integrated care for older people (ICOPE): guidance for person-centred assessment and pathways in primary care. Geneva: World Health Organization; 2019 (https://iris.who.int/ handle/10665/326843). 8. de Vet HCW, Terwee CB, Mokkink LB, Knol DL. Measurement in medicine: A practical guide. Cambridge: Cambridge University Press; 2011. 9. Long-term care for older people: package for universal health coverage. Geneva: World Health Organization; 2024 (https://iris.who.int/handle/10665/376585). 10. Rothman KJ, Lash TL, VanderWeele TJ, Haneuse S. Modern epidemiology. Fourth edition ed. Philadelphia: Wolters Kluwer; 2021. 11. Sanitation workers [website]. Geneva: World Health Organization; 2024 (https://www.who. int/teams/environment-climate-change-and-health/water-sanitation-and-health/sanitation- safety/sanitation-workers, accessed 21 October 2024). 12. To meet the unmet: Preparing for health equity challenges in WHO South-East Asia Region. New Delhi: World Health Organization Regional Office for South-East Asia; 2023 (https://iris. who.int/handle/10665/375911). 13. International Standard Classification of Occupations:ISO-08. Geneva: International Labour Organization; 2012 (https://ilostat.ilo.org/methods/concepts-and-definitions/classification- occupation/, accessed 21 October 2024). 14. Fragility fractures [website]. Geneva: World Health Organization; 2024 (https://www.who.int/ news-room/fact-sheets/detail/fragility-fractures, accessed 21 October 2024). 15. Ellis G, Sevdalis N. Understanding and improving multidisciplinary team working in geriatric medicine. Age Ageing. 2019;48(4):498–505. doi:10.1093/ageing/afz021. 16. Cesari M, Amuthavalli Thiyagarajan J, Cherubini A, Acanfora MA, Assantachai P, Barbagallo M, et al. Defining the role and reach of a geriatrician. Lancet Healthy Longev. 2024;Oct 4:100644. doi:10.1016/j.lanhl.2024.100644. 17. Healthcare-associated infections [website]. Atlanta: Centers for Disease Control and Prevention; 2020 (https://www.cdc.gov/healthcare-associated-infections/php/data/, accessed 21 October 2024). Introduction1 Framework2 Indicators3 Gaps4 Best practices5 References6 80 Measuring the progress and impact of the UN Decade of Healthy Ageing (2021–2030) 7Glossary 18. Health systems strengthening glossary. Geneva, Switzerland: World Health Organization, 2011 (https://cdn.who.int/media/docs/default-source/documents/health-systems-strengthening- glossary.pdf, accessed 21 October 2024). 19. Global Health Estimates: Life expectancy and healthy life expectancy. Geneva: World Health Organization; 2023 (https://www.who.int/data/gho/data/themes/mortality-and-global-health- estimates/ghe-life-expectancy-and-healthy-life-expectancy, accessed 21 October 2024). 20. Bull FC, Al-Ansari SS, Biddle S, Borodulin K, Buman MP, Cardon G, et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med. 2020;54(24):1451–62. doi:10.1136/bjsports-2020-102955. 21. Guideline on data integrity. Geneva: World Health Organization; 2019 (https://iris.who.int/ handle/10665/330818). 22. Decade of healthy ageing: baseline report. Geneva: World Health Organization; 2020 (https:// iris.who.int/handle/10665/338677). 23. Meaningful participation of older persons and civil society in policymaking. Geneva: United Nations Economic Commission for Europe; 2021 (https://unece.org/sites/default/files/2021- 09/UNECE%20meaningful%20participation%20guidance%20note.pdf, accessed 21 October 2024). 24. WHO. Progress report on the United Nations Decade of Healthy Ageing, 2021–2023. Geneva World Health Organization 2023. 25. National programmes for age-friendly cities and communities: a guide. Geneva: World Health Organization; 2023 (https://iris.who.int/handle/10665/366634). 26. Palliative Care [website]. Geneva: World Health Organization; 2024 (https://www.who.int/ teams/integrated-health-services/clinical-services-and-systems/palliative-care, accessed 21 October 2024). 27. WHO Mortality Database [website]. Geneva World Health Organization; 2020 ( https://platform. who.int/mortality/about/about-the-who-mortality-database, accessed 21 October 2024). 28. ICOPE Implementation pilot programme. Geneva: World Health Organization; 2020 (https:// www.who.int/teams/maternal-newborn-child-adolescent-health-and-ageing/ageing-and- health/integrated-care-for-older-people-icope/implementation-pilot-programme, accessed 21 October 2024). 29. Mishra P, Pandey CM, Singh U, Keshri A, Sabaretnam M. Selection of appropriate statistical methods for data analysis. Ann Card Anaesth. 2019;22(3):297–301. doi:10.4103/aca. ACA_248_18. 30. Theory of change. UNDAF Companion guidance. New York: United Nation Development Assistance Framework; 2020 (https://unsdg.un.org/sites/default/files/UNDG-UNDAF- Companion-Pieces-7-Theory-of-Change.pdf, accessed 21 October 2024). 31. Rosenberg M, Kowal P, Rahman MM, Okamoto S, Barber SL, Tangcharoensathien V. Better data on unmet healthcare need can strengthen global monitoring of universal health coverage. BMJ. 2023;382:e075476. doi:10.1136/bmj-2023-075476. 32. Inequality in unmet healthcare and social care needs in Europe. Kobe: WHO Centre for Health Development; 2023 (https://wkc.who.int/docs/librariesprovider24/wkc-projects-documents/ j0247-who-wkc-unmet-research-brief-v4-final.pdf, accessed 21 October 2024). Introduction 1 Framework 2 Indicators 3 Gaps 4 Best practices 5 References 6 817. Glossary of terms Annex 1. Proposed implementation activities for each action area in the World Health Assembly document Action 1: Changing how people think, feel and act towards age and ageing Action proposed for Member States • Adopt or ratify legislation to ban age-based discrimination and ensure mechanisms for enforcement. • Modify or repeal any laws, policies or programmes that permit direct or indirect discrimination based on age, in particular in health, employment and lifelong learning, and that prevent people’s participation and access to benefits. • Support the development and implementation of programmes to reduce and eliminate ageism in various sectors, including health, employment and education. • Support the collection and dissemination of evidence-based, age-disaggregated information about healthy ageing and the contribution of older people. • Support educational and intergenerational activities to reduce ageism and foster intergenerational solidarity, including activities in schools. • Support the development and implementation of activities to reduce self-directed ageism. • Conduct campaigns based on research on ageism to increase public knowledge and understanding of healthy ageing. Ensure that the media presents a balanced view of ageing. Action 2: Ensuring that communities foster the abilities of older people Action proposed for Member States • Establish or extend multisectoral mechanisms at national, subnational and local levels to promote healthy ageing, and address the determinants of healthy ageing, ensuring policy coherence and shared accountability. • Support inclusion of the voices of older adults, particularly in disenfranchised and marginalized groups, in multisectoral and multistakeholder platforms, processes and dialogues. • Promote and develop national and/or subnational programmes on age-friendly cities and communities, and engage with communities, older people and other stakeholders including the private sector and civil society, in designing these programmes. 82 Measuring the progress and impact of the UN Decade of Healthy Ageing (2021–2030) • Tailor advocacy to specific sectors on how they can contribute to healthy ageing. Take evidence-based action at all levels and sectors to foster functional ability and to strengthen the capacity of rural and urban communities to: – build knowledge and understanding of age and ageing and stimulate intergenerational dialogue, learning and collaboration; – extend options for housing, and improve modifications to their residences that enable older people to age in a place that suits their needs; – develop and ensure gender-responsive, affordable, accessible, sustainable mobility by complying with standards for accessibility in buildings and safe systems for transport, pavement and roads; – develop and ensure compliance with standards for access to information and communication technologies and assistive technology; – provide information and opportunities for leisure and social activities to facilitate inclusion, participation and reduce loneliness and social isolation. – provide training to improve financial and digital literacy and support in income security across the life-course, and protect older people, particularly women, from poverty, including through access to adequate social protection; – provide opportunities for lifelong learning, particularly for older women; – promote age diversity, improve workplace health and safety, and assist individuals to extend their working lives in decent work, including through support for retraining and assistance in finding jobs; – deliver comprehensive person-centred, integrated health and social care, including for people with dementia; – strengthen programmes and services to improve health literacy and self-management, and increase the opportunities for physical activity, good nutrition and oral health; and – prevent and respond to elder abuse in the community. • Develop contingency plans for humanitarian emergencies to ensure an age-inclusive response. • Allocate the necessary human and financial resources. • Collect, analyse and disseminate geographically disaggregated data. • Monitor and evaluate actions to implement what works. Action 3: Deliver integrated care and primary health services for older people Action proposed for Member States • Adopt and implement the WHO Integrated care for older people package, including guidance for person-centred assessment and pathways in primary care and other relevant WHO guidance, such as on reducing the risk of cognitive decline and dementia. • Assess the capacity and readiness of the health system to implement integrated care for older people, including in humanitarian emergencies. • Improve access to safe, effective, affordable essential medicines, vaccines, diagnostics and assistive technologies to optimize older people’s intrinsic capacity and functional ability. • Encourage use of safe, affordable, effective digital technology in integrated care. 83Annex 1. Proposed implementation activities for each action area in the World Health Assembly document • Analyse the labour market and conduct needs-based planning to optimize current and future workforces to meet the needs of ageing populations. • Develop a sustainable, appropriately trained, deployed and managed health workforce with competence in ageing, including for comprehensive person-centred assessments and the integrated management of chronic or complex health conditions, including dementia. • Assess and use public and private and combined public and private health financing models and their links with social protection systems (e.g. pensions and health protection) and long-term care. • Collect, analyse and report clinical data on intrinsic capacity and functional ability in national contexts, disaggregated by age, sex and other intersectional variables. • Scale up age-friendly primary health care to provide a comprehensive range of services for older people, including vaccination, screening, prevention, control and management of noncommunicable (including dementia) and communicable diseases and age-related conditions (e.g. frailty, urinary incontinence). • Ensure a continuum of care for older people, including promotion and preventive, curative, rehabilitative, palliative and end-of-life care, as well as specialized and long-term care. • Ensure that no older people are left behind, including indigenous elders, older people with disabilities and older refugees and migrants. Increase capacity for cross-sectoral collaboration in healthy ageing, including participation of civil society Action 4: Provision of long-term care to older people when they need it Action proposed for Member States • Ensure legal frameworks and sustainable financial mechanisms for provision of long- term care. • Support active engagement of older people and their families, civil society and local service providers in designing policies and services. • Steward the development of long-term care, and foster collaboration among stakeholders, including older people, their caregivers, nongovernmental organizations, volunteers and the private sector in providing long-term care. • Develop national standards, guidelines, protocols and accreditation for provision of community social care and support that are ethical and promote the human rights of older people and their caregivers. • Implement community services that comply with national standards, guidelines, protocols and accreditation for person-centred, integrated health and social care and support. • Develop and share models for provision of community social care and support, including in humanitarian emergencies. Use guidance and tools to prevent ageism and elder abuse in care provision. • Ensure appropriate use of and affordable access to innovative digital and assistive technologies to improve the functional ability and well-being of people who require long- term care. • Develop the capacity of the current and emerging formal workforce to deliver integrated health and social care. Ensure that formal and informal caregivers receive the necessary support and training. 84 Measuring the progress and impact of the UN Decade of Healthy Ageing (2021–2030) • Implement strategies for the provision of information, respite and support for informal caregivers, and flexible working arrangements. Structure financing models to support and sustain long-term care. • Foster a culture of care in the long-term care workforce, including men, younger people and non-family members, such as older volunteers and peers. • Ensure monitoring of quality of long-term care, impact on functional ability and well-being and continuous improvement of long-term care based on outcomes. • Work with other sectors and programmes to identify needs and gaps, improve living conditions and financial security and facilitate social engagement, inclusion and participation. 85Annex 1. Proposed implementation activities for each action area in the World Health Assembly document Annex 2. A compendium of indicators across four action areas for region and country selection CODE Indicators Domain Subdomain Mandated in existing global initiative Indicator type Tier Agesim Age friendly environment Integrated care Long- term care 1.1 Percentage of countries with a national focal point for ageing and health in the Ministry of Health or equivalent Political commitment and leadership Decade Input I Yes Yes Yes Yes 1.2 Percentage of countries that have organized a national campaign to reduce ageism in the past two years Political commitment and leadership Input I Yes Yes Yes Yes 1.3 Percentage of countries with national programmes to prevent abuse of older people Political commitment and leadership Input I Yes Yes Yes Yes 1.4 Percentage of countries with national programmes for age- friendly cities Political commitment and leadership Input I Yes Yes Yes Yes 2.1 Percentage of countries with current national policy, action plan, strategy or programme on ageing and health Policy and Legislation Decade Input I Yes Yes Yes Yes 86 M easuring the progress and im pact of the UN Decade of Healthy Ageing (2021–2030) CODE Indicators Domain Subdomain Mandated in existing global initiative Indicator type Tier Agesim Age friendly environment Integrated care Long- term care 2.2 Percentage of countries with current national legislation and enforcement strategies against age-based discrimination Policy and Legislation Decade Input I Yes 2.3 Percentage of countries with current national legislation, policies, strategies, frameworks, plans or programmes that include age- friendly environments Policy and legislation Decade Input I Yes 2.4 Percentage of countries with current national strategy, action plan, programme, policy and legislation that includes (incentives and resources) comprehensive assessments of the health and social care needs of older people Policy and legislation Decade Input I Yes Yes 2.5 Percentage of countries with current legislation or regulation that provides older persons with access to assistive products from the WHO Priority Assistive Products List Policy and legislation Decade Input I Yes Yes Yes 87 Annex 2. A com pendium of indicators across four action areas for region and country selection CODE Indicators Domain Subdomain Mandated in existing global initiative Indicator type Tier Agesim Age friendly environment Integrated care Long- term care 2.6 Percentage of countries with current national strategy, action plan, programme, policy and/ or legislation to support the implementation of long-term care for older persons Policy and legislation Decade Input I Yes 2.7 Percentage of countries with current national palliative care plan, programme, policy or strategy with a defined implementation framework Policy and legislation WHA resolution Input I Yes Yes 2.8 Percentage of countries with current national policies to support educational activities and intergenerational interventions to reduce ageism Policy and legislation Input I Yes 88 M easuring the progress and im pact of the UN Decade of Healthy Ageing (2021–2030) CODE Indicators Domain Subdomain Mandated in existing global initiative Indicator type Tier Agesim Age friendly environment Integrated care Long- term care 3.1 Percentage of countries with national multi- stakeholder forum or committee on ageing and health to support engagement of older people, families and caregivers across relevant sectors (e.g. health, social protection/welfare, labour, education, urban development, rural development, emergency etc) Voice and engagement Decade Input I Yes Yes Yes Yes 4.1 Percentage of countries with a national budget and financial resources to support initiatives to combat ageism Financial resources Input I Yes Yes Yes Yes 4.2 Percentage of countries with a national budget and financial resources to support activities to promote age-friendly cities and communities Financial resources Input I Yes Yes Yes Yes 4.3 Percentage of countries with a national budget and financial resources to implement integrated primary health care services for older people Financial resources Input I Yes 89 Annex 2. A com pendium of indicators across four action areas for region and country selection CODE Indicators Domain Subdomain Mandated in existing global initiative Indicator type Tier Agesim Age friendly environment Integrated care Long- term care 4.4 Percentage of countries with a national budget and financial resources to provide long- term care for older people (e.g. nationally budgeted financing schemes such as tax- based revenue or social insurance) Financial resources Input I Yes 4.5 Percentage of countries with public insurance that covers the cost of health care services for older people Financial resources Input I Yes Yes 4.6 Percentage of countries that support income- generating activities for older people Financial resources Input I Yes 4.7 Percentage of countries that provide free-of- charge outpatient services in the public sector for older people Financial resources Input I Yes 4.8 Proportion of total government spending on essential services (education, health and social protection) (SDG 1.a.2) Financial resources Input II depending on service Yes Yes Yes 90 M easuring the progress and im pact of the UN Decade of Healthy Ageing (2021–2030) CODE Indicators Domain Subdomain Mandated in existing global initiative Indicator type Tier Agesim Age friendly environment Integrated care Long- term care 5.1 Number of medical and nursing schools with geriatric care (formal education) in undergraduate curricula Workforce and training Input I Yes Yes 5.2 Number of geriatricians per 100 000 older people Workforce and training Input II Yes Yes 5.3 Number of nursing personnel with competencies in geriatric care per 100 000 older people Workforce and training Input II Yes Yes 5.4 Number of general medical practitioners with competencies in geriatric care per 100 000 older people Workforce and training Input II Yes Yes 5.5 Number of community health workers with competencies in geriatric care per 100 000 older people Workforce and training Input II Yes Yes 91 Annex 2. A com pendium of indicators across four action areas for region and country selection CODE Indicators Domain Subdomain Mandated in existing global initiative Indicator type Tier Agesim Age friendly environment Integrated care Long- term care 5.6 Number of formal care workers providing long-term care in various long-term care settings (including facilities and residential institutions) per 100 older people residing in long-term care facilities Workforce and training Input II Yes 5.7 Number of formal care workers providing long- term care for older people at home in the community, per 100 older people who need home-based long-term care Workforce and training Input II Yes Yes 5.8 Percentage of countries with capacity building and social support programmes (in-person or online) for caregivers of older people Workforce and training Input I Yes Yes 5.9 Number of physical therapists per 100 000 older people Workforce and training Input III Yes Yes 5.10 Percentage of countries with training programmes on age- friendly cities and communities Workforce and training Input I Yes 92 M easuring the progress and im pact of the UN Decade of Healthy Ageing (2021–2030) CODE Indicators Domain Subdomain Mandated in existing global initiative Indicator type Tier Agesim Age friendly environment Integrated care Long- term care 5.11 Percentage of countries with capacity-building plans to strengthen the geriatric and gerontology workforce Workforce and training Input I Yes Yes 5.12 Number of clinical social workers per 100 000 older people Workforce and training Input III Yes Yes 5.13 Number of psychologists per 100 000 older people Workforce and training Input III Yes Yes 5.14 Number of environment and public health workers Workforce and training Input III Yes 6.1 Percentage of countries with age and sex- disaggregated data on older people in routine health information systems Data and Information systems Input I Yes Yes 6.2 Percentage of countries with any cross- sectional survey(s) on healthy ageing with a nationally representative sample of older people Data and Information systems Decade Input I Yes Yes Yes Yes 93 Annex 2. A com pendium of indicators across four action areas for region and country selection CODE Indicators Domain Subdomain Mandated in existing global initiative Indicator type Tier Agesim Age friendly environment Integrated care Long- term care 6.3 Percentage of countries with the longitudinal survey(s) on healthy ageing with a nationally representative sample of older people Data and Information systems Decade Input I Yes Yes Yes Yes 6.4 Percentage of countries that have data on cities, towns and rural areas that are recognized as age-friendly Data and Information systems Input I Yes 6.5 Number of countries that have national statistical legislation that complies with the Fundamental principles of official statistics (SDG 17.18.2) Data and Information systems SDG Input I Yes Yes Yes Yes 7.1 Percentage of primary care or any other health facilities offering care services defined in the WHO ICOPE UHC packages of care services Availability of care services Output III Yes 7.2 Percentage of streets in the neighbourhood that have pedestrian paths which meet locally accepted standards over the past year Availability of care services Output II Yes 94 M easuring the progress and im pact of the UN Decade of Healthy Ageing (2021–2030) CODE Indicators Domain Subdomain Mandated in existing global initiative Indicator type Tier Agesim Age friendly environment Integrated care Long- term care 7.3 Percentage of public transport vehicles with designated places for older people or people with disabilities Availability of care services Output II Yes 7.4 Percentage of age- friendly communities providing information about health concerns and service referrals other than the internet to older people Availability of care services Output II Yes 8.1 Percentage of older people with unmet health care needs, over the past year Accessibility of care services Output II Yes Yes Yes 8.2 Percentage of older people with unmet long-term care needs, over the past year Accessibility of care services Output II Yes Yes Yes 8.3 Percentage of older people aged 60 years and over forgone care due to cost, distance or sociocultural factors, over the past year Accessibility of care services Output III Yes Yes Yes 8.4 Percentage of new and existing public spaces and buildings that are fully accessible by wheelchair over the past year Accessibility of care services Output II Yes 95 Annex 2. A com pendium of indicators across four action areas for region and country selection CODE Indicators Domain Subdomain Mandated in existing global initiative Indicator type Tier Agesim Age friendly environment Integrated care Long- term care 8.5 Percentage of older people who reported that they have convenient access to public transport over the past year (modified SDG 11.2.1) Accessibility of care services SDG Output II Yes 8.6 Percentage of new and existing houses of older people that have wheelchair-accessible entrances Accessibility of care services Output II Yes 8.7 Percentage of older people reporting that they have convenient access to lavatories/ public toilets over the past year Accessibility of care services Output II Yes 9.1 Percentage of older people who reported out-of-pocket expenditure on any health care services over the past year Affordability of care services Output III Yes Yes 9.2 Percentage of older people who reported out-of-pocket expenditure on any long-term care services over the past year Affordability of care services Output III Yes 96 M easuring the progress and im pact of the UN Decade of Healthy Ageing (2021–2030) CODE Indicators Domain Subdomain Mandated in existing global initiative Indicator type Tier Agesim Age friendly environment Integrated care Long- term care 9.3 Proportion of health facilities that have a core set of relevant essential medicines available and affordable on a sustainable basis (SDG 3.b.3) Affordability of care services SDG Output II Yes 10.1 Percentage of cities, towns, and rural areas working to become age-friendly communities over the past year Fostering age-friendly communities Output III Yes 10.2 Percentage of cities, towns, and rural areas working to become age-friendly communities that have completed a baseline assessment over the past year Fostering age-friendly communities Output III Yes 10.3 Percentage of cities, towns, and rural areas working to become age-friendly communities that have developed a strategy and action plan over the past year Fostering age-friendly communities Output III Yes 97 Annex 2. A com pendium of indicators across four action areas for region and country selection CODE Indicators Domain Subdomain Mandated in existing global initiative Indicator type Tier Agesim Age friendly environment Integrated care Long- term care 10.4 Percentages of cities, towns, and rural areas working to become age-friendly communities that have completed an evaluation over the past year Fostering age-friendly communities Output III Yes 10.5 Percentage of cities, towns, and rural areas working to become age-friendly communities that have completed more than one cycle of assessment-strategy- evaluation over the past year Fostering age-friendly communities Output III Yes 10.6 Proportion of cities with a direct participation structure of civil society in urban planning and management that operate regularly and democratically (SDG 11.3.2) Fostering age-friendly communities SDG Output II Yes 98 M easuring the progress and im pact of the UN Decade of Healthy Ageing (2021–2030) CODE Indicators Domain Subdomain Mandated in existing global initiative Indicator type Tier Agesim Age friendly environment Integrated care Long- term care 10.7 Average share of the built-up area of cities that is open space for public use for all (SDG 11.7.1) Fostering age-friendly communities SDG Output I Yes 11. 1 Percentage of older people engaged in intergenerational initiatives over the past year Inter- generational initiatives Output III Yes Yes 12.1 Percentage of older people who have received cataract surgery and have a resultant good quality outcome (6/12 or better) relative to the number of people in need of cataract surgery over the past year Quality of health and long-term care services WHA resolution Outcome II Yes 12.2 Percentage of older people who have received refractive error services (that is, spectacles, contact lenses or refractive surgery) and have a resultant good quality outcome relative to the number of people in need of refractive error services over the past year Quality of health and long-term care services WHA resolution Outcome II Yes Yes 99 Annex 2. A com pendium of indicators across four action areas for region and country selection CODE Indicators Domain Subdomain Mandated in existing global initiative Indicator type Tier Agesim Age friendly environment Integrated care Long- term care 12.3 Number of older patients per 1000 who have prescriptions for benzodiazepines for more than one year Quality of health and long-term care services Outcome II Yes Yes 12.4 Number of older persons per 1000 taking five are more medications daily over the past year Quality of health and long-term care services Outcome II Yes Yes 12.5 Percentage of older people with at least one healthcare- associated infection in the long-term care facilities, over the past year Quality of health and long-term care services Outcome II Yes Yes 12.6 Percentage of older people who reported age-based discrimination in health or long-term care services, over the past year Quality of health and long-term care services Outcome II Yes Yes 12.7 Percentage of older people who received surgical treatment for hip-factures within 48 hours after admission to the hospital, over the past year Quality of health and long-term care services Outcome II Yes Yes 100 M easuring the progress and im pact of the UN Decade of Healthy Ageing (2021–2030) CODE Indicators Domain Subdomain Mandated in existing global initiative Indicator type Tier Agesim Age friendly environment Integrated care Long- term care 13.1 Percentage of older people who received screening for health and social care needs (annual health check) over the past year Coverage of health and long-term care services Outcome II Yes Yes 13.2 Percentage of older people who received comprehensive health and social care needs assessment over the past year Coverage of health and long-term care services Outcome II Yes Yes 13.3 Percentage of older people with malnutrition who received nutritional care services over the past year Coverage of health and long-term care services Outcome II Yes Yes 13.4 Percentage of older people with declines in mobility or locomotor capacity who received rehabilitation services over the past year Coverage of health and long-term care services Outcome III Yes Yes 13.5 Percentage of older people at risk of falls who received rehabilitation care services over the past year Coverage of health and long-term care services Outcome II Yes Yes 101 Annex 2. A com pendium of indicators across four action areas for region and country selection CODE Indicators Domain Subdomain Mandated in existing global initiative Indicator type Tier Agesim Age friendly environment Integrated care Long- term care 13.6 Percentage of older people with urinary incontinence who received incontinence care services over the past year Coverage of health and long-term care services Outcome II Yes Yes 13.7 Percentage of older people in need of hearing aids who received hearing aid services over the past year Coverage of health and long-term care services Outcome III Yes Yes 13.8 Percentage of older people diagnosed with depression who received psychosocial, pharmacological, rehabilitation and/ or aftercare services over the past year Coverage of health and long-term care services Outcome III Yes Yes 13.9 Percentage of older people diagnosed with dementia who received pharmacological, psychosocial rehabilitation and / or aftercare services over the past year Coverage of health and long-term care services Outcome II Yes Yes 102 M easuring the progress and im pact of the UN Decade of Healthy Ageing (2021–2030) CODE Indicators Domain Subdomain Mandated in existing global initiative Indicator type Tier Agesim Age friendly environment Integrated care Long- term care 13.10 Percentage of older people diagnosed with cognitive impairment who received pharmacological, psychosocial, rehabilitation, and/or aftercare services over the past year Coverage of health and long-term care services Outcome II Yes Yes 13.11 Percentage of older people diagnosed with substance use disorders who received pharmacological, psychosocial, rehabilitation and/or aftercare services over the past year (modified SDG 3.5.1) Coverage of health and long-term care services SDG Outcome II Yes Yes 13.12 Percentage of informal caregivers (of older people in need of support) who received caregiving training over the past year Coverage of health and long-term care services Outcome III Yes Yes 103 Annex 2. A com pendium of indicators across four action areas for region and country selection CODE Indicators Domain Subdomain Mandated in existing global initiative Indicator type Tier Agesim Age friendly environment Integrated care Long- term care 13.13 Percentage of older people in need of long- term care services receiving long-term care at facilities or in their home in the community over the past year Coverage of health and long-term care services Outcome II Yes Yes 13.14 Percentage of older people who have experienced a fragility fracture of the hip or the spine, or more than one fracture treated with anti-osteoporosis medication over the past year Coverage of health and long-term care services Outcome II Yes Yes 13.15 Percentage of older people who received influenza vaccination over the past year Coverage of health and long-term care services Outcome II Yes Yes Yes 13.16 Percentage of older people with chronic low back pain who received care services as defined in the UHC package over the past year Coverage of health and long-term care services Outcome III Yes Yes 104 M easuring the progress and im pact of the UN Decade of Healthy Ageing (2021–2030) CODE Indicators Domain Subdomain Mandated in existing global initiative Indicator type Tier Agesim Age friendly environment Integrated care Long- term care 13.17 Percentage of older persons in need of long-term care receiving long- term care services recommended in the WHO-LTC UHC packages of care services over the past year Coverage of health and long-term care services Outcome III 14.1 Percentage of older people who reported that they feel safe walking alone in their neighbourhood after dark, over the past year (modified SDG 16.1.4) Age-friendly environment Outdoor spaces and buildings SDG/ Decade Outcome II Yes 14.2 Percentage of older people who report that their neighbourhood is suitable for walking, including for those who use wheelchairs and other mobility aids, over the past year Age-friendly environment Outdoor spaces and buildings Decade Outcome II Yes 14.3 Percentage of older people who reported that public spaces and buildings in their community are accessible, over the past year Age-friendly environment Outdoor spaces and buildings Decade Outcome II Yes 105 Annex 2. A com pendium of indicators across four action areas for region and country selection CODE Indicators Domain Subdomain Mandated in existing global initiative Indicator type Tier Agesim Age friendly environment Integrated care Long- term care 14.4 Percentage of health facilities (primary health care, hospitals, or long-term care) that are age-friendly Age-friendly environment Outdoor spaces and buildings Decade Outcome II Yes Yes 14.5 Percentage of older people reported that they are satisfied with transportation or alternative provisions for mobility over the past year Age-friendly environment Transportation Decade Outcome II Yes 14.6 Percentage of older people reported that house is adapted, or can be adapted, to their needs to facilitate ageing at home/compliant with universal design standards over the past year Age-friendly environment Housing Decade Outcome II Yes 14.7 Percentage of older people living in households with access to basic services, over the past year (modified SDG 1.4.1) Age-friendly environment Housing SDG/ Decade Outcome II Yes 106 M easuring the progress and im pact of the UN Decade of Healthy Ageing (2021–2030) CODE Indicators Domain Subdomain Mandated in existing global initiative Indicator type Tier Agesim Age friendly environment Integrated care Long- term care 14.8 Percentage of the older people living in slums, informal settlements or inadequate housing, over the past year (modified SDG 11.1.1) Age-friendly environment Housing SDG/ Decade Outcome II Yes 14.9 Percentage of older people with access to electricity, over the past year (modified SDG 7.1.1) Age-friendly environment Housing SDG/ Decade Outcome I Yes 14.10 Percentage of older people reported being involved in decision-making about important political, economic and social issues in the community, over the past year Age-friendly environment Civic participation & employment Decade Outcome II Yes 14.11 Percentage of older people active in the labour market, over the past year (modified SDG 8.5.2) Age-friendly environment Civic participation and employment SDG/ Decade Outcome I Yes 14.12 Percentage of older people who are satisfied with the opportunities for paid employment, over the past year Age-friendly environment Civic participation and employment Decade Outcome II Yes 107 Annex 2. A com pendium of indicators across four action areas for region and country selection CODE Indicators Domain Subdomain Mandated in existing global initiative Indicator type Tier Agesim Age friendly environment Integrated care Long- term care 14.13 Percentage of eligible older people who voted in the most recent local election or legislative initiative Age-friendly environment Civic participation and employment Decade Outcome II Yes 14.14 Percentage of older people satisfied with their past experience of public services such as health care, education or any government services, over the past year (modified SDG 16.6.2) Age-friendly environment Civic participation and employment SDG Outcome II Yes 14.15 Percentage of older people who believe decision-making is inclusive and responsive, over the past year (modified SDG 16.7.2) Age-friendly environment Civic participation and employment SDG Outcome II Yes 14.16 Percentage of older people who own a mobile telephone, over the past year Age-friendly environment Communication and information Decade Outcome II Yes 14.17 Percentage of older people who used the Internet from any location in the past three months (modified SDG 17.8.1) Age-friendly environment Communication and information SDG Outcome II Yes 108 M easuring the progress and im pact of the UN Decade of Healthy Ageing (2021–2030) CODE Indicators Domain Subdomain Mandated in existing global initiative Indicator type Tier Agesim Age friendly environment Integrated care Long- term care 14.18 Percentage of older people with information and communications technology (ICT) skills, by skill type over the past year (modified SDG 4.4.1) Age-friendly environment Communication and information SDG Outcome II Yes 14.19 Percentage of older people who participated in sociocultural activities at their own discretion at least once a week, over the past year Age-friendly environment Social participation Decade Outcome II Yes Yes 14.20 Percentage of older people who report engaging in volunteer activity at least once (weekly, monthly), over the past year Age-friendly environment Social participation Decade Outcome II Yes Yes 14.21 Percentage of older people experiencing loneliness, over the past year Age-friendly environment Respect and Social Inclusion Decade Outcome II Yes Yes Yes Yes 14.22 Percentage of older people experiencing social isolation, over the past year Age-friendly environment Respect and Social Inclusion Decade Outcome II Yes Yes 109 Annex 2. A com pendium of indicators across four action areas for region and country selection CODE Indicators Domain Subdomain Mandated in existing global initiative Indicator type Tier Agesim Age friendly environment Integrated care Long- term care 14.23 Percentage of older people subjected to (a) physical violence, (b) psychological violence and/or (c) sexual violence in the previous 12 months (modified SDG 16.1.3) Age-friendly environment Respect and Social Inclusion SG Outcome II Yes Yes 14.24 Percentage of older people who report feeling respected and socially included in their community, over the past year Age-friendly environment Respect and Social Inclusion Decade Outcome II Yes 14.25 Percentage of older people living in age- friendly cities, towns, and rural areas Age-friendly environment Respect and Social Inclusion Decade Outcome II Yes 15.1 Percentage of older people who reported using tobacco daily, over the past year Risk factors Outcome II Yes Yes 15.2 Percentage of older people who reported insufficient physical activity, over the past year Risk factors Outcome I Yes Yes Yes 15.3 Percentage of older people who reported falls inside and home, over the past year Risk factors Outcome II Yes Yes Yes 110 M easuring the progress and im pact of the UN Decade of Healthy Ageing (2021–2030) CODE Indicators Domain Subdomain Mandated in existing global initiative Indicator type Tier Agesim Age friendly environment Integrated care Long- term care 15.4 Percentage of older people who reported falls outside the home, over the past year Risk factors Outcome II Yes Yes Yes 15.5 Percentage of older people who reported any fracture, over the past year Risk factors Outcome II Yes Yes Yes 15.6 Percentage of older people experiencing underweight, over the past year Risk factors Outcome I Yes Yes Yes 15.7 Percentage of older people experiencing overweight and obesity, over the past year Risk factors Outcome I Yes Yes Yes 15.8 Alcohol per capita consumption in older people within a calendar year in litres of pure alcohol over the past year (modified SDG 3.5.2) Risk factors SDG Outcome I Yes Yes 16.1 Percentage of older people living in poverty in all its dimensions according to national definitions over the past year (modified SDG 1.2.2) Social protection SDG Outcome I Yes 111 Annex 2. A com pendium of indicators across four action areas for region and country selection CODE Indicators Domain Subdomain Mandated in existing global initiative Indicator type Tier Agesim Age friendly environment Integrated care Long- term care 16.2 Percentage of older people effectively covered by a social protection “floors” or systems over the past year (modified SDG 1.3.1) Social protection SDG Outcome I Yes 16.3 Percentage of older people who did not have enough income to meet their basic needs without public or private assistance, over the past year Social protection Outcome III Yes 16.4 Proportion of older people living in a household with a disposable income above the risk-of poverty threshold over the past year Social protection Outcome III Yes 16.5 Prevalence of undernourishment in older people over the past year (modified SDG 2.1.1) Social protection SDG Outcome I Yes 112 M easuring the progress and im pact of the UN Decade of Healthy Ageing (2021–2030) CODE Indicators Domain Subdomain Mandated in existing global initiative Indicator type Tier Agesim Age friendly environment Integrated care Long- term care 16.6 Prevalence of moderate or severe food insecurity in the older people, based on the Food Insecurity Experience Scale over the past year (modified SDG 2.1.2) Social protection SDG Outcome II Yes 17.1 Percentage of older people who reported that others do not value their contribution, others may feel frustrated by them because of their age, and/or others make decisions for them because of their age over the past year (interpersonal ageism) Ageism Decade Outcome III Yes Yes 17.2 Percentage of older people limiting participation in discussion about things that affect them over the past year (self- directed ageism) Ageism Decade Outcome III Yes Yes 113 Annex 2. A com pendium of indicators across four action areas for region and country selection CODE Indicators Domain Subdomain Mandated in existing global initiative Indicator type Tier Agesim Age friendly environment Integrated care Long- term care 17.3 Percentage of older people that report that policies made by the government do not meet their needs, due to discrimination on age nested in the policy over the past year (institutional ageism) Ageism Decade Outcome III Yes Yes 17.4 Percentage of older people who reported age-based discrimination any services (excluding health and long-term care) over the past year Ageism Decade Outcome III Yes Yes 17.5 Percentage of older people reporting having personally felt discriminated against or harassed in the previous 12 months on the basis of a ground of discrimination prohibited under international human rights law over the past year (modified SDG 10.3.1) Ageism SDG/ Decade Outcome II Yes Yes 114 M easuring the progress and im pact of the UN Decade of Healthy Ageing (2021–2030) CODE Indicators Domain Subdomain Mandated in existing global initiative Indicator type Tier Agesim Age friendly environment Integrated care Long- term care 18.1 Percentage of older people with higher intrinsic capacity, over the past year Intrinsic Capacity Decade Outcome III Yes Yes Yes Yes 19.1 Percentage of older people with higher functional ability, over the past year Functional Ability Decade Outcome III Yes Yes Yes Yes 20.1 Percentage of older people who are care- dependent, over the past year Care dependence Outcome III Yes Yes Yes 20.2 Proportion of time spent (in 24 hours) by family caregivers on unpaid care work for older people over the past year (SDG 5.4.1) Care dependence SDG outcome II Yes Yes Yes 21.1 Healthy life expectancy at age 60 over the past year Long and healthy life Decade Impact I Yes Yes Yes Yes 21.2 Life expectancy at age 60 over the past year Long and healthy life Decade Impact I Yes Yes Yes Yes 22.1 Percentage of older people with higher well-being (subjective), over the past year Well-being Impact III Yes Yes Yes Yes 115 Annex 2. A com pendium of indicators across four action areas for region and country selection Annex 3. Monitoring and evaluation plan template Monitoring and evaluation (M&E) plan template for National strategy and action plan on healthy ageing 1. Introduction and background • Purpose of the M&E plan: – Describe the purpose and importance of the M&E plan for the National strategy and action plan on healthy ageing. – Outline how the M&E plan will be used to track progress, assess outcomes, and inform decision-making. • Program/strategy description: – Provide a brief overview of the National strategy and action plan on healthy ageing, including its goals, objectives, target population, and key activities. – Include relevant background information on the ageing population and key challenges addressed by the strategy. 2. M&E objectives • Specific objectives: – Clearly define the objectives of the M&E plan. For example: ‚ Monitor the implementation of the national strategy. ‚ Evaluate the effectiveness and impact of the actions taken. ‚ Provide data for evidence-based policymaking and adjustments. 3. Theory of change and measurement framework • Theory of change (ToC): – Develop a narrative or diagram that explains how the activities and interventions of the National strategy on healthy ageing are expected to lead to the desired outcomes and impacts. • Monitoring and evaluation framework or logical framework (log frame): – Outline the inputs, activities, outputs, outcomes, and impacts of the strategy. – Include a summary table with indicators for each level (inputs, process, outputs, outcomes, impacts). 116 Measuring the progress and impact of the UN Decade of Healthy Ageing (2021–2030) 4. Indicators • Indicator definitions: – List key indicators that will be used to measure progress at various levels. Examples include: ‚ Long and healthy lives indicator: Life expectancy at age 60, healthy life expectancy at age 60. ‚ Quality of care indicator: Effective coverage of cataract surgery, coverage of rehabilitation services for decline in locomotor capacity. ‚ Age-friendliness of environment indicators: Safe neighbourhood (feel safe walking alone in their neighbourhood after dark). ‚ Social protection indicators: Employment rates among older adults, pension coverage, financial security. • Baseline data: – Provide the baseline data for each indicator to establish a starting point for tracking progress. • Target values: – Define the target values or milestones that the strategy aims to achieve over the defined period (e.g. annual targets, mid-term targets). 5. Data collection methods • Data sources: – Identify the primary data sources (e.g. national surveys, administrative records, interviews, focus groups). • Data collection tools: – Specify the tools and methodologies used for data collection (e.g., questionnaires, checklists, electronic data systems). • Data collection schedule: – Provide a timeline for data collection activities, including frequency (e.g., quarterly, annually) and responsible parties. 6. Data management • Data storage and security: – Outline procedures for storing data securely and maintaining data confidentiality and integrity. • Data processing and analysis: – Describe the methods for processing and analysing data to generate meaningful insights for decision-making. 7. Reporting and dissemination • Reporting mechanisms: – Specify the types of reports to be generated (e.g. quarterly progress reports, annual evaluation reports) and their frequency. 117Annex 3. Monitoring and evaluation plan template – Define the content and structure of the reports, including key findings, recommendations, and actions taken. • Dissemination strategy: – Target audiences: Identify the stakeholders and audiences who need to receive the M&E findings, such as government agencies, development partners, civil society, and the public. – Communication channels: Specify the communication channels to be used for dissemination, including websites, newsletters, press releases, workshops, and conferences. – Dissemination tools: Describe the tools and formats for presenting M&E findings, such as policy briefs, infographics, presentations, and full reports. – Feedback mechanism: Include a process for gathering feedback from stakeholders on the M&E findings to improve future reporting and decision-making. 8. Roles and responsibilities • M&E team: – Define the roles and responsibilities of the M&E team members, including data collection, analysis, reporting, and dissemination. 9. Stakeholder engagement strategy • Outline the involvement of stakeholders (e.g., government ministries, NGOs, UN agencies) in the M&E process. • Describe consultation mechanism, capacity building, and communication and feedback mechanism for meaningful engagement. 10. Capacity building • Training and resources: – Identify any training needs for the M&E team or stakeholders to enhance their technical capacity in M&E. • Resources: – Provide information on the resources (e.g., financial, technical, human) needed to implement the M&E plan effectively. 11. Budget • M&E budget: – Provide a detailed budget outlining the financial resources required for implementing the M&E plan, including data collection, analysis, reporting, and dissemination activities. 118 Measuring the progress and impact of the UN Decade of Healthy Ageing (2021–2030) • Budget components of a monitoring system Budget components of a monitoring system Fixed cost Personnel costs Centre: Percentage of a monitoring and evaluation (M&E) coordinator’s time to manage M&E system, can range from 10% to 100%, based on the scale of the national programme on ageing Local: Typically, 50–100% of a local M&E officer’s time to manage implementation of M&E activities, plus junior support staff Equipment Computers, voice recorders, and cameras Software Licences for quantitative and qualitative analysis tools Other costs Training Capacity building for personnel, enumerators, and community members Travel Travel from HQ to the field for periodic check-ins and technical assistance. Local travel to field sites to ensure standardized implementation of M&E activities Data collection and analysis Contracting of third-party vendors, such as survey firms Consultants Contracting of external experts for specific tasks Printing Instruments, reports 12. Evaluation plan • Evaluation questions: – Define the key evaluation questions that the evaluation will seek to answer, focusing on the strategy’s effectiveness, efficiency, impact, and sustainability. • Evaluation design: – Describe the evaluation design (e.g. formative, summative, impact evaluation) and methodology, including data sources and analysis methods. • Evaluation schedule: – Provide a timeline for conducting evaluations, including key milestones and deliverables. 13. Ethical considerations • Ethical guidelines: – Outline ethical guidelines for data collection, particularly concerning informed consent, privacy, and the protection of vulnerable populations (e.g. older persons). • Ethics review: – Ensure that the M&E plan adheres to ethical standards and has undergone appropriate ethics review, if necessary. 119Annex 3. Monitoring and evaluation plan template 14. Risk management • Risk identification: – Identify potential risks that could impact the implementation of the M&E plan (e.g. political changes, funding shortfalls, data collection challenges). • Mitigation strategies: – Outline strategies to mitigate identified risks and ensure continuity in M&E activities. 15. Review and adaptation • Plan for review: – Establish a mechanism for periodically reviewing and updating the M&E plan to adapt to changes in the strategy, program context, or external environment. • Adaptation: – Define the process for making necessary adjustments to the M&E plan based on feedback and lessons learned. 16. Annexes • Annex 1. Detailed logical framework • Annex 2. Indicator meta-data with data collection tools and method of measurement • Annex 3. M&E budget breakdown • Annex 4. Reporting templates • Annex 5. List of stakeholders and contact information 120 Measuring the progress and impact of the UN Decade of Healthy Ageing (2021–2030)

M easuring the progress and im pact of the UN Decade of Healthy Ageing (2021–2030) For more information: World Health Organization 20, avenue Appia 1211 Geneva 27 Switzerland tagha@who.int