Every so often I feel compelled to write about ageism, a prejudice so ingrained in Irish society that few people recognise it.
Recent rumours that the free travel scheme for pensioners might be confined to certain times of the day brought the ageists out in force. Commentators rushed to point out the importance of free travel so that “the elderly”, can attend their “clinic and hospital appointments”. “It’s their lifeline,” exclaimed others.
The impression given is that anyone over 66 is in constant need of medical attention and has such a limited social life that their free travel pass is the only thing that gets them out of the house. The media and health professionals seem to be unable to talk about older people as other than needy and a burden on the State/taxpayer/ younger people.
Ageism is an insidious and pervasive negative belief system. It stereotypes everyone over 60 as dependent, sick, frail, decrepit, and a drain on the economy. Reports on older people’s health invariably whinge about the costs of long-term residential care. Metaphors such as “ticking time bomb” are used to describe the costs of future care.
Just under €1 billion was spent on the Fair Deal Nursing Home Support Scheme (NHSS) in 2014. Yet the State spends more than €11 billion a year, almost the same as the entire HSE budget, on services for children and young people, who are also unproductive members of society (from an economic perspective). No one grudges it because this group is seen as comprising potential contributors. Ageism ensures people over 60 are depicted as takers, users and overall big minuses for society.
Public policy
Ageism influences public policy. The NHSS, a scheme little better than warehousing older people until they die, is one example of ageist health policy. The
2015 Review of the Nursing Homes Support Scheme,
A Fair Deal
, shows the average cost of a home help is €3,900; a homecare package €7,000; and a nursing home bed €44,000. The high cost of nursing home beds ensures there is never enough funding to provide community and home supports, which are what older people want. Fewer people are now in receipt of home help than in 2008. Nearly 12 million hours were delivered to 55,000 people in 2008 and 47,500 received the service in 2014. Homecare packages, which can include home-help services, increased during this period but the overall budget allocation for all homecare services (home-help and homecare packages) reduced from €331 million in 2009 to €315 million in 2014.
Yes, older people can and do develop chronic health problems, such as cardiovascular disease, dementia and diabetes, but this is not inevitable. Childhood experiences, educational attainment and physical activity determine almost all aspects of health in the over-60s. A 2015 Tilda (the Irish longitudinal study on ageing) study of 6,912 adults over 50 found that adverse experiences during childhood were associated with an increased risk of disease in later life. The findings “reinforce the necessity of adopting a life-course approach [to health]”.
Another study published in the Lancet Neurology in July, found that, worldwide, the most important risk factor for poor health in older age was low educational attainment. In Europe and the US, the next most important risk factor was physical inactivity. "Attention to optimum health early in life" and "upstream primary prevention has the largest effect on reduction of later dementia occurrence and disability".
Despite the huge body of evidence, ageism ensures health is not seen as a continuum from birth to death and the link between childhood, mid-life and older people’s health is not recognised.
Ageist attitudes among professionals and politicians ensure that upstream policies are not prioritised. The NHSS is about as downstream as it is possible to get. Current policy means children’s services are provided by the public sector, and services for older people are provided by the private sector. This is grossly unfair.
The 2015 Ageing Report: Economic and Budgetary Projections for the 28 EU Member States (2013-2060) (iti.ms/1KOiuha) notes that "whilst ageing per se has a non-negligible effect on expenditure, it is rather moderate. In effect, much depends on whether gains in life expectancy are spent in good or bad health."
A life-course approach will ensure they are more likely to be spent in good health. As for the free travel scheme, the trick is to stay fit to use it as much as possible.
drjackyjones@gmail.com Jacky Jones is a former HSE regional manager of health promotion and a member of the Healthy Ireland council