Tessa Richards: Responding to the ageing “crisis”

Tessa RichardsIs our increasing life expectancy something to celebrate or despair of? It’s a question that’s exercising several sectors right now and it’s not hard to see why. All societies are ageing, but the fastest population increase is among the “oldest old,” and their projected need for health and long term care is daunting.

Currently around 1.4 million UK citizens are over 85. By 2035 the UK Office for National Statistics estimates it will be 3.6 million. Data from the Organisation for Economic Co-operation and Development (OECD) paint a similar picture and in its recent report, entitled Help Wanted, it estimates that the proportion of people over 80 will increase from a current  4% to 10% by 2050.

OECD countries spend 1.5% of their GDP on long term care at the moment. But this proportion is likely to triple by 2050, by which time who knows what dizzy heights healthcare costs will have reached. The report takes a searching look at how, and who, will pay for long term care and who will look after the elderly. It also sets out a raft of policy actions on funding and improving the supply of long term care workers and warns that “muddling through” is not an option.

Many of the responses to the ageing crisis were debated at the European Observatory on Health Systems and Policies summer school. In a gathering where those over 60, let alone 80, were noticeable by their absence, the mood was upbeat. Initiatives to promote healthy ageing, roll out best practice in health promotion and disease prevention, integrate health and social care, create age friendly housing and environments, and capitalise on the much vaunted but curiously elusive potential of new technologies, were discussed with enthusiasm. But it proved hard to keep reality under the carpet. It was agreed that we will all have to pay the price for our increased longevity, although it may carry a few silver linings. Older societies might result in less social unrest and surely the influence of grandparents will improve child rearing?

Challenged to provide priorities for action the representatives from the international organisations came up with the following action points. Jorge Pinto from DG SANCO (the commission’s health directorate) urged EU member states to up the ante on promoting “voluntarism.” Countries should incentivise people, especially older people, to learn new skills, keep working, and swell the ranks of informal carers. Countries should also get better evidence on the cost effectiveness of health interventions and ensure that as much health and social care as possible is moved out of expensive institutional settings. We should also look a lot harder at the best ways to manage frailty and multimorbidity.

Manfred Huber, from the WHO Regional Office for Europe, took off his official hat to argue for better supportive packages for informal carers. His advice on tackling the financial challenge of caring for the new army of the aged, was to raise the price of alcohol and tobacco. He also repeated what was a widely made call for greater integration of health and social systems, not least to reduce avoidable hospital admissions and improve hospital discharge policies.

Taking a closer look at who currently cares for elderly people and adopting measures to give them more support, improve their work-care balance, and provide respite care, was emphasised by Jerome Mercier from the OECD. In addition he urged for greater transparency on the extent to which rich countries depend on workers (employed legally and illegally) from poor ones. A trend which sits uncomfortably alongside the recently agreed WHO code on ethical recruitment.

Another action, widely called for, was better coordination between ministries. Working in silos to provide innovative “solutions” to providing and paying for the care of elderly people makes little sense. Policy responses to our success in the longevity stakes would benefit from joined-up thinking.

Tessa Richards is analysis editor, BMJ.