SPEECH BY THE HON. ANTOINE MIFSUD BONNICI, PARLIAMENTARY SECRETARY IN THE MINISTRY FOR SOCIAL POLICY, AT SEMINAR ON "FUNCTIONAL MOBILITY IN OLD AGE" – 27th January, 2001

In the Preamble of the Vienna International Plan of Action on Ageing ratified by the countries gathered in the World Assembly on Ageing in July/August 1982 it is written down that the countries:

1) Do solemnly reaffirm their belief that the fundamental and inalienable rights enshrined in the Universal Declaration of Human Rights apply fully and undiminishedly to the ageing; and,

2) Do solemnly recognise that quality of life is no less important than longevity, and that the ageing should therefore, as far as possible, be enabled to enjoy in their own families and communities a life of fulfilment, health, security and contentment, appreciated as an integral part of society.

Ageing is not a disease and cannot be prevented. Age treats everyone differently. Some people remain active and productive as they age, others lose their capacity to function and become disabled. Active Ageing in the 21^st Century presupposes the fact that quality of life in old age is influenced mainly by health factors. Recommendation 2 of the Vienna International Plan of Action on Ageing states that: "The care of the elderly persons should go beyond disease orientation and should involve their total well-being, taking into account the inter-dependence of the physical, mental, social, spiritual and environmental factors. Health care should therefore involve the health and social sectors and the family in improving the quality of life of older persons. Health efforts, in particular primary health care as a strategy, should be directed at enabling the elderly to lead independent lives in their own family and community for as long as possible instead of being excluded and cut off from all activities of society."

Although ageing is irreversible, many of the problems of old age can be prevented or ameliorated. Most of the problems of older people are not caused by the ageing process but by disease, loss of fitness and the social changes that accompany ageing. Environmental factors, the life style of the person, early diagnosis of disease, adaptation to increasing disability and to a sense of usefulness and value greatly influence health in old age. An active policy to promote health among the elderly does not aim to keep a person alive irrespective of the quality of that life. Its goal is to reduce morbidity among the elderly or as one eminent physician said, to enable people to "die young as late as possible".

The promotion of health amongst the elderly is closely linked to promoting the health of the population generally. Health promotion policies aim to add life to years by enabling as many persons as possible to remain healthy and active throughout the years of their life; to add health to life by reducing the occurrence of illness and accidents and to add years to life by increasing the average life expectancy of the individual. A successful policy of health promotion would enable more people to reach old age, reduce the incidence of disease and handicaps among the elderly and increase the number of elderly who are healthy and active.

Ageing is a highly individual experience. Chronological age may differ from a person's functional age. Age related changes occur at different rates for different persons. The ageing process is a very natural one. It begins at conception and continues throughout the life cycle. The manner in which someone ages depends on heredity, physical health, nutrition, mental and other unknown factors. Physical decline caused by ageing is best dealt with through community services that support independent living, mutual aid (self-help) and health promotion.

The provisions of resources to maintain the elderly person at home represents the typical situation of social autonomy in which family and community support services compensate for disabilities. The admission of an elderly person to a long-term care institution results from an imbalance between the individual's disabilities and resources, especially social resources, available to him or her. A man who cannot perform domestic tasks, regardless of the reason, is disabled and must rely on his social resources, usually represented by his wife, to compensate for the disabilities. These cultural and social disabilities are real, since with the loss of the resource, the handicaps generated are often sufficient to justify admission to an institution.

Physical activity enhances health at any age and may be especially important in maintaining mobility and independence. The World Health Organisation's motive for Targets in its Health for All Strategy is nowhere better exemplified than in the case of physical activity. Adding years to life alone is meaningless without a safe guard of adding health to life. A regular routine of sustained physical activity promotes better health at every stage of life, enhancing both physical and mental well being and not simply warding off disease. Maintainingsuch a life-style in the later life promotes a greater reserve capacity for dealing with life's ups and downs, sustaining the ability to remain economically active and to participate more completely in family and community life. In this way, physical activity contributes to the greatest goal of all – that of adding life to years.

Functional mobility in old age is definitely not prejudiced in certain cases. In many parts of the world, even today, older persons in great numbers are still actively engaged in agricultural activities as an economic necessity for survival. For these, accustomed to life long physical labour, there is no slowing until serious illness, disability, or even death itself overcomes them. We ought to take a closer look at the social and physical norms determining our range of activities through our lifestyles and ultimately influencing the quality of our life, to the extent that some researchers have come to describe exercise as "the closest thing to an anti-ageing pill".

Functional mobility in old age is of prime importance in housing and environment. Adequate living accommodation and agreeable physical surroundings are necessary for the well being of all people, and it is generally accepted that housing has a great influence on the quality of life of any age group in any country. Suitable housing is even more important to the elderly, whose abodes are the centre of virtually all of their activities. Adaptations to the home, the provision of practical domestic aids to daily living and appropriately designed household equipment can make it easier for those elderly people whose mobility is restricted or who are otherwise disabled to continue to live in their homes. When ever possible, the ageing should be involved in housing policies and programs for the elderly population. Housing for the elderly must be viewed as more than mere shelter. In addition to the physical, it has a psychological and social significance, which should be taken into account.

Functional mobility in old age is also at a disadvantage in the cases where the elderly meet manifold problems in traffic and transport. Especially elderly pedestrians have to cope with objective or subjectively felt dangers that restrict and limit their mobility and participatory aspirations. The traffic circumstances should be adapted to older people instead of the other way around. Measures and facilities should include traffic education, speed limits especially in human settlements, traffic-safe environments, accommodation and means of transport, etc.

Special attention should be paid to environmental problems and to designing a living environment that would take into account the functional capacity of the elderly and facilitate mobility and communication through the provision of adequate means of transport.

The living environment should be designed, with support from Governments, local authorities and non-governmental organisations, so as to enable elderly people to continue to live, if they so wish, in locations that are familiar to them, where their involvement in the community may be of long standing and where they will have the opportunity to lead a rich, normal and secure life.

Functional mobility in old age should also be kept in mind in the education field. Governments and international organisations should support programmes aimed at providing the elderly with easier physical access to cultural institutions (museums, theatres, opera houses, concert halls, cinemas, etc) in order to encourage their greater participation in leisure activities and the creative use of their times.

Ladies and Gentleman, may I conclude this short address by quoting what His Excellency, Dr Boutros Boutros Ghali, had to say on the occasion of the first International Day for the Elderly, 1^stOctober, 1991: "As we celebrate this international day, let us honour the elderly, and appreciate their tremendous diversity. Let us commit ourselves once again to the goals of the International Plan of Action on Ageing, which calls upon the international community to enhance the lives of older persons, so that they can enjoy their advancing years in peace, health and security. And let us ensure that the elderly, in both developing and developed countries, continue to participate fully, as an integral and valued part of our communities, in the activities and development of our societies."

To ensure this full participation of the elderly, we have to enhance the functional mobility of the older persons. I feel certain that today you will have a fruitful debate on this theme. You will certainly discuss the importance and evaluate the efficiency and efficacy of Physical Therapy in the field of ageing in the present and in the future in the preservation or the recuperation, as the case may be, of functional mobility in the old age. While congratulating the Division of Gerontology and Geriatrics of the University of Malta and the Maltese Association of Gerontology and Geriatrics for organising this seminar, I augur a successful outcome to this seminar.

Thank you.