Healthy ageing over the life-course
As health in old age is shaped by accumulated disadvantages and buffering resources over the life-course of the individual in his/her wider context, a true comprehensive approach to enhance health and well-being at old age should target factors as they unfold over the relevant phases of the life-course. This comprehensive longitudinal approach challenges current policies and practices with a local focus since risk factors for refugees and migrants unfold in the country of birth, along the migration trajectory and in the country of destination.
There is a need for a special focus on diseases known to be of higher prevalence in older refugees and migrant groups. This should be embedded within gender-sensitive and age-relevant frameworks to accommodate for diversity across social identities and life-course phases.
Important focus areas are poor mental health, long-term effects of traumatic experiences and social isolation in widowed or lone refugees and migrants or in the oldest old population of refugees and migrants living with frailty.
Supportive environments
The third sector, and in particular social enterprises run by refugees and migrants in their communities, may provide important, yet untapped, resources of engagement and social participation for older refugees and migrants.
Collaborations with NGOs based in local communities may enhance access to support needed at old age, in particular for single or isolated older refugees and migrants.
Informal caregivers should be supported to avoid overburdening these individuals while also ensuring access to formal care when needed.
For strategy and programme purposes, estimation of care demands and preferences among older refugees and migrants is needed.
Special focus should be given to ensuring age-friendly communities, including adequate housing, outdoor areas and community services in areas with high proportions of older refugees and migrants, who are often of lower socioeconomic position.
People-centred health and long-term care services
Overall, diversity-sensitive policies and practices across health and long-term care facilities for older adults are needed to ensure that all people and communities, including older refugees and migrants, can use the services they need, that these services are of sufficient quality to be effective and their use does not expose the user to financial hardship. Ensuring access to skilled interpreters in both health and long-term care systems is an integral part of universal health coverage and
Services specifically targeted to older refugees and migrants may be warranted to respond to issues such as language and culture-specific needs, or to ensure outreach that will bridge between available services and underserved groups. This includes providing materials in relevant languages; delivering activities relevant for specific religious practices, such as informing on health dimensions of fasting;
or recruiting into mainstream services through involvement of cultural mediators.
Sharing of knowledge and experiences in services development, implementation and advocacy for older refugees and migrants across countries is needed to develop best practices and leverage resources and capabilities across the WHO European Region.
Older refugees and migrants, given the heterogeneity of their life-courses and migration trajectories, must be involved in formulating and shaping their care based on principles of inclusive, people-centred care provision. User engagement tools building on elucidating life-stories, illness perceptions and care needs and preferences are important, although to the best of our knowledge few tools have been tested in older refugee and migrant populations.
Implementation of diversity training across professions in health and long-term care sectors is needed to ensure provision of culturally appropriate, people-centred and inclusive care for all older adults irrespective of country of birth. A variety of delivery modes should be considered, including webinars, training programmes, written material, case studies and supervision. Involvement of older refugees and migrants in material such as framing case studies should be encouraged.
Strengthening the evidence base and research
Monitoring of health and utilization of health and long-term care facilities for older refugees and migrants is needed at country levels. This will facilitate accountability towards ensuring the right to health for all groups, as well as allowing for identification of underserved and/or at-risk groups in need of policy and practice initiatives. A minimal set of indicators is needed to facilitate comparisons across countries, and data should be segregated by factors such as country of birth, ethnicity, sex, age and socioeconomic position.
More detailed analysis of the range of individual, social and structural factors shaping health among older people in general, and in refugee and migrant groups in particular, is needed. This will help to unpack the relative and combined effects of general socioeconomic circumstances (e.g. income, education and housing conditions) and factors specific for refugees and migrants (e.g. risks along the migration trajectory, cultural norms, language barriers and dispersed social networks) feeding into interventions.
More systematic evaluations of policy and practice initiatives for, or inclusive of, older refugees and migrants are needed to strengthen the evidence base.
More applied, participatory research is needed to ensure diversity sensitivity in emerging practice initiatives. Theory-driven evaluation and complex intervention designs may bring important insights into what works for whom in what settings
and why, thereby bringing in the role of context for transferability of interventions across groups, settings and countries.
More insight into access to and quality of health and long-term care for older refugees and migrants is needed to identify informal and structural barriers to be overcome when working towards diversity-sensitive care provision. Particular emphasis should be on identifying vulnerable groups with complex needs and/or suboptimal access.
More research into the role of different formal and informal community organizations, settings and resource personnel is needed, including potential gaps in service delivery reflected in the involvement of informal sectors.
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