International Journal of Older People Nursing最新文献

Over 200 health journals call on the United Nations, political leaders and health professionals to recognise that climate change and biodiversity loss are one indivisible crisis and must be tackled together to preserve health and avoid catastrophe. This overall environmental crisis is now so severe as to be a global health emergency.

The world is currently responding to the climate crisis and the nature crisis as if they were separate challenges. This is a dangerous mistake. The 28th Conference of the Parties (COP) on climate change is about to be held in Dubai while the 16th COP on biodiversity is due to be held in Turkey in 2024. The research communities that provide the evidence for the two COPs are unfortunately largely separate, but they were brought together for a workshop in 2020 when they concluded that: ‘Only by considering climate and biodiversity as parts of the same complex problem…can solutions be developed that avoid maladaptation and maximize the beneficial outcomes’. (Otto-Portner et al., 2021).

As the health world has recognised with the development of the concept of planetary health, the natural world is made up of one overall interdependent system. Damage to one subsystem can create feedback that damages another—for example, drought, wildfires, floods and the other effects of rising global temperatures destroy plant life, and lead to soil erosion and so inhibit carbon storage, which means more global warming (Ripple et al., 2023). Climate change is set to overtake deforestation and other land-use change as the primary driver of nature loss (European Academies Science Advisory Council, 2021).

Nature has a remarkable power to restore. For example, deforested land can revert to forest through natural regeneration, and marine phytoplankton, which act as natural carbon stores, turn over 1 billion tonnes of photosynthesising biomass every 8 days (Falkowski, 2012). Indigenous land and sea management has a particularly important role to play in regeneration and continuing care (Dawson et al., 2021).

Restoring one subsystem can help another—for example, replenishing soil could help remove greenhouse gases from the atmosphere on a vast scale (Bossio et al., 2020). But actions that may benefit one subsystem can harm another—for example, planting forests with one type of tree can remove carbon dioxide from the air but can damage the biodiversity that is fundamental to healthy ecosystems (Levia et al., 2020).

Human health is damaged directly by both the climate crisis, as the journals have described in previous editorials (Atwoli et al., 2021, 2022) and by the nature crisis (WHO, UNEP, Convention on Biological D, 2015). This indivisible planetary crisis will have major effects on health as a result of the disruption of social and economic systems—shortages of land, shelter, food a

Around the world, hospitals are used more by older people than any other demographic, but hospitals are often as bad for the health and function of older people as they are for the planet. We nurses know well that hospitals are laden with risks to older people's health and function. What we know less well is that hospitals' outsized greenhouse gas emissions and waste streams harm the planet, significantly contributing to the triple planetary health crisis. The triple planetary crisis (https://unfccc.int/blog/what-is-the-triple-planetary-crisis) is comprised of climate, air pollution, and biodiversity crises and is fundamentally a health crisis. Abbasi and colleagues (2023) make the magnitude of this global health crisis abundantly clear. For us as gerontological nurses, this global planetary health crisis threatens healthy ageing for every one of every age around the world. While hospitals sit at the centre of the healthcare system in most societies, they are not friendly to ageing, older people, or the planet.

Despite known harms and risks for older people and for healthy ageing, hospitals respond sluggishly to the need to reduce these concerns. In this way, health care is unlike in other industries, where targeting ways to better meet the needs of a major user group are typically viewed as a priority. For example, uptake of the well-established Age Friendly Health Systems (https://www.ihi.org/Engage/Initiatives/Age-Friendly-Health-Systems/Pages/default.aspx) and Practice Greenhealth (https://practicegreenhealth.org) initiatives here in the United States where I live are inconsistent at best. Both programmes remain far from becoming national requirements for healthcare delivery, and participation is the exception and not the rule. The same lag in achieving age friendly and planet friendly hospitals is true elsewhere, too, despite widespread assumptions that hospitals effectively care for older people and will promote health rather than harming it through damage to the planet.

In most societies around the world, the default approach to addressing care for hospitalized older people is piecemeal, using a culture of performance improvement. Most performance improvement projects targeting older patients focus on focal concerns like fall rates, delirium screening, or hospital length of stay. These endeavours target deleterious events and outcomes older people commonly endure in hospitals but without getting at the underlying factors that link them together. At best, such projects promote age friendly working. More commonly, though, they inadvertently promote functional loss, overuse of long-term care facilities, and caregiving burdens, all while not considering planetary sustainability. Inequitable outcomes for older people and those who love them are thus the more common result.

Social discrimination renders older people invisible such that their health equity is rarely considered. In health care and beyond, we expec