Capitalising on the Co-Benefits of Age Friendliness and Planet Friendliness

Abstract

Gerontological nurses around the world are increasingly and acutely aware that health and social care must become age friendly. The manifold, cascading effects of structural ageism and lack of gerontological competence in health and social care professions and systems are now widely recognised (Fulmer et al. 2020). Thus, many of us are fighting for age friendly transformation of health and social care systems in countries around the world. Ever more, many gerontological nurses see similar concerns with planet friendliness and the negative impact of the healthcare industry on the health of the planet. Growing numbers of gerontological nurses and others are concerned that the healthcare industry worldwide is a major producer of greenhouse gases and a significant contributor to plastic pollution (Rizan et al. 2020; Rodríguez-Jiménez et al. 2023). Nurses everywhere, along with their colleagues in other disciplines, want to help mitigate the greenhouse gas and plastic pollution that the healthcare industry—in which most of them work and all of them use as patients and care partners—produces. As our recognition of these threats to the planet and its population builds, few of us stop to think about how naturally age friendliness and planet friendliness fit together.

Simply said, what is age friendly is most often planet friendly and vice versa. Pause and consider what we know about healthful ageing and what healthcare must do to support it. Supporting healthful ageing and respecting the person as they grow older both lie at the centre of age friendliness. The core elements of age friendliness are most often described with words beginning with M, forming a mnemonic to enhance recall and application. The M's used most often are knowing the person and what matters to them, promoting mobility and fitness, supporting mentation and brain health, and avoiding overuse and misuse of medications. Careful examination reveals that each of these elements is fundamentally planet friendly. Knowing the person is foundational, helping to avoid misplaced and excessive healthcare, especially that which is carbon intensive including all but the most imperative use of emergency, acute, and critical care. Mobility and fitness easily align with avoiding use of fossil fuel powered transportation while spending more time in nature moving under our own power. Brain health and physical fitness are inextricably linked, highlighting that fit bodies and fit brains rely on consistent physical exercise and lifelong social engagement. Finally, avoiding excessive and misapplied medications limits both greenhouse gas emissions and plastic waste used in producing and packaging drugs while simultaneously reducing risks of potential medication-related complications. Together, each domain of age friendly healthcare benefits our shared planetary environment.

Conversely, planet friendly healthcare easily promotes age friendliness. The acute care sector in healthcare is the most carbon intensive. All the work that we gerontological nurses do to help older people and their care partners succeed in avoiding needs for and limiting stays in emergency, acute, and critical care is simultaneously age and planet friendly. This sector is rife with potential threats to older people's health (e.g., increased risk of deconditioning) while it emits significant volumes of greenhouse gases and uses massive quantities of single-use and other plastic products. Going forward, our emphasis on considering options to substitute a higher carbon choice of healthcare or replace plastic products with those that have less impact on the environment can help mitigate the planetary crisis while benefiting healthful ageing. Such dual returns are called co-benefits in the world of environmental sustainability (Barrett 2022). Offering guidance about a plant-based diet that is sourced locally, when possible, can help limit the use of higher carbon health services and reduce the carbon impact of dietary choices over time. Our efforts to help older people prevent or treat chronic conditions similarly offer co-benefits. Think of continence care and its connections to physical fitness in the core strength, general mobility, and cognitive functioning needed for toilet use. When we promote continence, our nursing care is fundamentally age friendly as it promotes mobility, mentation and what matters as well as potentially improving medication use. Excitingly, something that seems so familiar to us as gerontological nurses is also clearly planet friendly as we help those in our care avoid the plastic and general waste of incontinence management products and limit excess water use for laundry by improving their level of function.

The analysis of interlinked age and planet friendliness is indeed exciting to contemplate. What is even more invigorating is thinking about how to make these co-benefits of age friendliness and planet friendliness a daily reality in our research, practice, education, policy advocacy, and activism. Advantageously, commonly used models for age friendly healthcare—typically the 4M's model of age friendly health systems (Mate et al. 2021) and the 5M's of geriatric medicine (Tinetti, Huang, and Molnar 2017)—are very amenable to repurposing in research and in education given that they already show utility in clinical practice. Models for planet friendly healthcare are less familiar. Focusing on quality improvement proves useful here. Fundamentally, making healthcare as well as social care planet friendly requires us to undertake widespread quality improvement to reduce pollution while maximising value to individual and population health.

The Centre for Sustainable Healthcare (https://sustainablehealthcare.org.uk/) in Oxford, England offers a useful framework. The Centre for Sustainable Healthcare's SusQI model (Mortimer et al. 2018) (https://www.susqi.org/) gives us a model and the tools to make all our quality improvement work planet friendly. SusQI is guided by a value proposition balancing health outcomes for individuals and populations against the so-called triple bottom line, borrowed from the corporate world, of impact created in achieving those outcomes in social, environmental and financial terms. The Centre for Sustainable Healthcare offers a step-by-step guide to SusQI (https://www.susqi.org/step-by-step-guide) and a useful library of templates and other resources (https://www.susqi.org/templates). The Centre thus makes it easy to apply SusQI in healthcare, a model that I see as relevant in social care settings as well.

Some scrutiny reveals that overlaying age friendly models onto SusQI is easily done, further directing age friendly, planet friendly quality improvement. My preference is to apply an age friendly model—keeping in mind that we need to account for both frailty and psychosocial complexity when using the 4M's model—in each of the five SusQI steps. While we may choose one of the age friendly M's as the focus for our goal, the remaining M's always remain influential in system assessment and improvement design. Moreover, we can expect co-benefits reaching across the other M's. Similarly, co-benefits to the planet come through influence in different sectors such as greenhouse gas emissions, air quality, and plastic pollution. Achieving a goal to improve medication use, for example, is likely to realise improvements in some combination of what matters, mentation, and mobility. At a population level, planetary co-benefits are likely to be realised over time in directly in measurably diminished plastic pollution and indirectly in the lessened carbon impact of realigned medication manufacturing and in healthcare use for medication-related events.

The International Journal of Older People Nursing is, of course, a research journal. While we publish editorials, commentaries, and reviews of books and media, our main aim is to publish reports of the research conducted by gerontological nurses and their colleagues from countries all around the world. Quality improvement, evidence-based practice, and research overlap in important ways (Grys 2022). Thus, the transfer of both age friendly models—such as 4M's and 5M's—and planet friendly healthcare models—like SusQI—to research is easily achieved. Studying models for both age friendly and planet friendly healthcare with an eye toward future research allows us to frame new questions for scientific inquiry or reframe current programs of research.

Most essentially, when investigating a question or specific aim within an age friendly domain, applying the SusQI value proposition aids in specifying intended outcomes for a group or a population in relation to particular social, environmental and financial impacts of achieving those outcomes. We can even take the value proposition a further step, relying on current conversations about a quadruple bottom line in the business world, to consider a fourth class of impact, that on culture. For us as gerontological nurses, the mandate to achieve a precise focus on healthcare and wider culture, sociocultural discrimination, and specifically ageism—both individual and structural—is clear. The planetary health crisis is racist, sexist and ageist. We can and must examine the impact that any research we conduct using age and planet friendly precepts has on culture and social discrimination.

As this new year of 2025 stretches before us, I am very much looking forward to reading your manuscripts reporting age friendly, planet friendly gerontological nursing research. I realise, however, that conceiving, designing, implementing, conducting and reporting rigorous and robust research takes time. I will wait patiently through this year and into the next, hoping that I have succeeded in inspiring you with my proposal that we as a community of gerontological nurses and colleagues embark upon age friendly, planet friendly research. Meanwhile, I hope that current and prospective authors, peer reviewers and readers will reach out via social media or email with questions and ideas along with updates on the research and quality improvement projects they have underway.

Please note that the International Journal of Older People Nursing's social media streams are changing! You can still find us on Facebook at https://www.facebook.com/IJOPN/. We closed our X/Twitter account in December of last year. In the coming months, I will introduce you to our newest social media editor, I-Chun Chen, who joins senior social media editor, Ellen Munsterman, and social media editor, Tope Omisore, in showcasing what the journal is publishing and in highlighting news and other media relevant to ageing, older people, care partners and gerontological nursing. Going forward, Ellen, I-Chun, Tope and I will outline a new social media strategy for IJOPN. It will create a new presence on different platforms along with refreshed aims for engaging you, our readers, reviewers, authors and other groups. For now, we invite you to use our hashtag #GeroNurses and tag us on Facebook! And, for those who are not using social media, please reach out via email with your questions. Until next time, my wish for us all is a safe, peaceful, healthy and happy 2025, made better by age friendly, planet friendly gerontological nurses and their colleagues through research, quality improvement, evidence-based practice, education and activism.

The author declares no conflicts of interest.