Tessa Richards at the World Demographic Association’s 3rd “World Ageing and Generations Congress,” September 6-9

“The older I get the greater power I seem to have to help the world; I am like a snowball the further I am rolled the more I gain” Susan Anthony (suffragist) 1890-1906.
On the airport bus en route to the conference I eavesdrop on a conversation which contains the words “patient” and “the NHS.” Emboldened, I accost my two travelling companions … only to find that they are heading to a meeting on spinal injury. In passing l learn that the publicity generated by “Superman” Christopher Reeves has raised unrealistic expectations about functional recovery in patients with paraplegia. In reality, I learn, what’s improved for these patients is life expectancy.
It’s a good introduction to my meeting, where an eclectic mix of nearly 600 academics, financial services providers, business gurus, politicians, and policy makers, from 45 different countries, are set to debate the impact of demographic change. One backdrop to this meeting is last month’s report from the UN Population Division. This shows that the proportion of the world’s population aged over 60 has been rising steadily. In 1950 it was 8%, currently it’s 11%, and the projected figure for 2050 is 22%.
Time is short so I treat myself to a taxi the station to the University of St Gallen, where the congress is being held. When the taxi driver establishes I’m English he breaks into a beaming smile. “I’m from Kosovo, “he says, “God bless the English. God bless John Major. God bless Tony Blair.”
It’s a great welcome, and as I walk into the lobby of a concrete building redolent of London’s South Bank, I find the conference participants in equally cheerful mood despite the warnings of Alexandre Sidoerenko, head of the United Nations Focal Point on Ageing. He underlined that international initiatives on ageing, including the Madrid Action Plan, have failed to persuade governments to grasp and respond to the policy implications of demographic change. What was needed, he said was a new UN interagency body, UNAGE, modelled on UNAIDS, to “spearhead” coordinated action. But Ilona Kickbusch, the meeting’s expert chair, had clearly raised morale, making the case that our ageing world presents more opportunities than threats. She has also got delegates’ feet tapping to a video clip of “The Zimmers” belting out the Who’s “Thinkin’ about my … generation.”
I catch up with the Zimmers’ video clip over coffee and discover that the lead singer of this rock group is 90; the members’ combined age an improbable 3000. (No, I don’t know how many there of them but if you want chapter and verse, YouTube is, apparently, the place to go.)
The band play quietly on a screen in the hall throughout the meeting, alternating with interviews with serious looking men talking about the financial, social and health, aspects of ageing, shots of white haired adventurers white water rafting, and a few seconds of Martina Navratilova—an icon for the fit over 50—throwing balls at an unseen audience.
The screen has been set up by AARAP (www.arp.org) a non-governmental organisation with a membership of 39 million set up to represent and address the needs of people over the age of 50. As one its target audience I take a look at their impressive range of publications, including the one with the subtitle “Your health, your money, your world. “ I note the articles on “Why aren’t women getting the same care for heart disease than men?” and read a scathing commentary on the US’s Food and Drug Administration, which has been recently been hauled over the coals for failing to monitor the safety of new drugs.
Then it’s on to a session on “Life expectancy: trends and implications.” Joining the meeting by satellite David Bloom, professor of economics and demography at Harvard University School of Public Health, tells us that the one thing (possibly the only thing) demographers agree on is that life expectancy will continue to rise over the next few decades. How much is anyone’s guess. The forecast ranges from 2.5 years per decade to 6 months. Much depends on the impact of climate change, AIDS, war, and new and re-emerging infectious diseases. Then there is the global obesity epidemic to factor in, and its impact clearly worries Jay Olshansky, an epidemiologist from the school of public health at Illinois. Although in theory it’s fixable, he says, in practice it’s only getting worse, and he had the data to prove it. When the impact of childhood obesity kicks in he believes longevity in the US and maybe Europe too, will start to decline.
The crucial question of course is whether most of us age well and keep mentally alert and sprightly to the last (and this apparently correlates very closely with the numbers of years you spend in education) or badly, with an expensive set of comorbidities. Tom Kirkwood, professor of biological gerontology at Newcastle University, is reassuring upbeat on this. Backing his view with some of the latest findings on the biology of ageing he insists that “Long lives don’t have to be more onerous.”
Its a myth to say that healthcare cost are rising because of demographic change—they are rising because we do more, he says. Over 90% of healthcare costs occur in the last 6 months of life, and they are same if you die young or if you die old. If the old can be persuaded and supported to continue as active producers and consumers the net effect on the economy will be positive. It’s not demographic change and falling fertility rates we need to worry about, he insists, but overpopulation. This, he argues, is the world greatest global challenge.
As the session opens to the floor it’s clear that most people agree on the potential of well educated ageing baby boomers to play an active role in society, but concern is voiced about widening of the gap in life expectancy between the rich and poor both within and between countries.
Parallel sessions follow plenaries, and I learn that the one word that should always be avoided when marketing products to the over 50s is “seniors.” As I sit through a session led by managers from a variety of sectors involved in marketing services for older people I learn a lot on how to do this in a way that respects them and, of course, entices them to use or buy services. Many in people in the NHS could do with a revision on course on this topic, I muse.
Over “nightcap” discussions” (it’s all go), Alexandre Kaleche, head of WHO’s Ageing and Life programme, tells a small group about WHO’s initiatives on ageing. These include a new primary care “tool kit,” which will be launched next week and is freely available to all. Its aim is to help health professionals run “age friendly” health centres. It includes advice about combating ageism and screening for the 4 giants of geriatric medicine: depression, cognitive impairment, reduced mobility, and incontinence.
As the small group unwinds, I admire Kaleche’s skilful diplomacy, which ensures that all members of the group participate in the discussion. So often, meeting chairs (and I plead guilty as charged) fail to silence loud voices and encourage the reticent. We discuss how to improve public awareness about ageism, and how to combat it. Will recruiting big names as advocates help? Alex has tried. It seems that the likes of Richard Branson and Jane Fonda will agree to campaign on almost any cause … other than the rights of elderly people. It’s just not a sexy subject.
We scratch our heads a bit further as ideas are mooted on how best to push the message that social isolation, exclusion, and poor housing are as detrimental to health and wellbeing as chronic disease, and that “soft” interventions to promote health and independence reap more dividends that high tech medical care.
Over breakfast the next day I talk to a man from the US who is in the business of building homes for the elderly. I describe my father’s last home, which was unquestionably “state of the art” and his eyes light up. He pulls out a map which shows where his organisation has built homes in the UK. I have not the heart to say that my father would have much preferred to end his days in a smaller, shabbier house, with a garden to pretend to dig in, a fence to mend, and a shed into which he could slink off and smoke a cheroot.
The first session the next day starts at 8.30 am (and I walk up the hill this time). By the time formal proceedings end I have picked up a lot messages. These include a clear warning to employers to rethink their ageist attitudes. Early retirement is bad for the economy. I don’t follow all the arguments but it seems that that there is plenty of evidence that longevity can pay dividends. Diverse workforces are “good things.” Young employees can learn from older ones, and vice versa. The important thing is to think long term, look hard at the 35-50 year old group and work out how to retain them (and recruit others) by offering flexible working, new skills training, and financial incentives to stay in work.
At national level, Lord Adair Turner, chair of the UK pensions commission, has a straightforward message. The pensions “crisis” is exaggerated and can be effectively tackled by pinning retirement age to life expectancy. The figures I jot down read “expect it get it at 68.5 years in 2050 and 70.2 by 2070.” Interestingly he too pushes the message that it’s not demographic change but population growth which should be worrying us, especially where birth rates are soaring as they are in Pakistan and Uganda.
The third message is that lifelong learning is the key to “ever greening” along with physical exercise and avoidance of the usual risk factors. How you do this is up to you, but I was fascinated by evidence presented on how cognitive function may be arrested from its inevitable decline by playing an adult version of Nintendo .I don’t personally feel any compunction to rush off and use an adult “Gameboy” to calculate my brain age, but I was impressed by the modest and measured presentation from Ryuta Kawashima. He is professor at the department of functional brain imaging at Tohoku University in northern Japan, and his description of the research and development of the tool and its use and seemingly impressively good effect on patients with advanced dementia was riveting. The answer to the question “Is it being formally compared in randomised trials against new drug treatments?” was yes.
But arguably the most important message from the day’s session was that ageing is hitting poor countries a lot harder than rich ones. The phrase I kept hearing as the conference wore on is that “developing countries are getting old before they get rich.” Isabella Aboderin, from the Oxford Institute of Ageing, was among several speakers to provide sobering information on the plight of the 36 million people who are over 60 in sub-Saharan Africa—and by 2050 their number will rise to 140 million. Only 6 countries provide pensions, and the majority of elderly people are left to eke out their life in extreme poverty, marginalised from an increasingly fragmented society, and burdened with the responsibility of caring for grandchildren as their own children migrate to cities or succumb to AIDS. Humanitarian and other international interventions, which are largely targeted at the young and middle aged, largely pass them by. Without power, a voice, basic human rights or access to health care, their plight could scarcely contrast more sharply with most of their counterparts in developed countries.
Things are apparently not much better in South Asia, where again, we were told, there is inadequate pension provision. This coupled with the relatively “lowly” position of women and their increased longevity compared to men, results in women carrying the largest burden of chronic poverty.
On the final morning, as we take our seats I note that numbers remain high. Always a good sign in any meeting. But maybe it’s the pull of the speaker. Baroness Sally Greengross, long a passionate advocate for the elderly, does not disappoint. She speaks movingly about old people being seen as “a race apart,” and a “burden on the young.” Her anecdotes of inhumane care of older patients in the NHS make me, as on of the relatively few UK members of the audience, ashamed.
She repeats Sidoerenko’s message about the (in this case UK) governments slowness to appreciate the need to factor into its agenda the policy implications of our ageing population. It must invest in older people, she urges, and ensure that they get the same level of care as other age groups and the same opportunities to fulfil their potential.
She refers to a new UK initiative which she thinks may be used to help counter discrimination against the elderly. The Commission for Equality of Human Rights starts will be launched in 3 weeks and as one its commissioners her aim is to ensure that age gets as high a profile as race, gender, disability and sexual orientation. Societies need to be at ease with diversity, she tells us, and a balance struck between the rights and interests of all age groups.
A debate on how to promote intergenerational solidarity would be good but time has run out and the meeting is closing with the award of the Prix de Generations to Waris Dirie for her fight against female genital mutilation. Her acceptance speech makes me realise just how much this debate is needed. Still relatively young and glamorous her final words are that (given the grim scenario) she is “sure going to avoid getting old.”
A “frisson” goes through the hall among delegates who are mostly a good 20 years older, but they part with good cheer. The superb organisation and expert chairing has kept us to time with an accuracy that matches Federer’s backhand. But the catalyst has been the stimulation that comes from getting together a diverse international intersectoral group united by a common cause. Dirie would have done better to acknowledge that their fight might make a difference to her future.
Press releases and further information about the congress can be obtained from the secretariat (sraf@wdassociation.org) of the World Demographic Association (www.wdassociation.org)
Tessa Richards, BMJ