Wising up to what works

We are faced with unprecedented ageing.  Those over 85 will reach 2.8 million by 2030, a doubling of present numbers.  Such numbers are enough to raise panic in the Treasury, if the prevailing scenarios of cost are to be believed.

Conversely, I have always thought that we should celebrate our increased longevity as an enormous success story for society. I have been encouraged in my belief by the increasing evidence of the contribution that older people make and the progress that is being made, albeit slowly, in reducing the years we spend in ill health.

440x210_dr_blood-pressureSpeaking recently with media I was struck by the number of presenters who, like me, concluded that ‘we’re not really ready for this, are we?’  It is one thing to age and another to age well, but the revolution in longevity is going to completely re-structure society.

We will need new solutions, new approaches and most of all new evidence on what truly works.  Simply increasing expenditure in itself is not an option because there is little evidence that much – some would say any – of what we do is cost-effective. Consider the escalating NHS budget: £43.5bn in 1988; £64bn in 1998 and a staggering £120bn (8% of GDP) in 2008 – without any corresponding reduction in demand or focus on outcomes.

The improvement in healthcare in the last fifty years must rank as one of the most impressive periods of advancement in human history.  For some 2,000 years, doctors sought in vain for ‘magic bullets’ to resolve the multiple health problems of the society around them. Then, suddenly and apparently without warning, they came cascading out of the research laboratories.  Antibiotics, open-heart surgery, transplants, new drugs, CAT-scans and test tube babies. All of them based on evidence. Rich, certain, empirical evidence. We have witnessed Cochrane, NICE, systematic reviews and randomised clinical trials –  all of it providing a mandate of evidence on which to base policy and practice.

The same cannot be said of social or even economic policy. The quality of evaluation is variable. Evidence is weak in some areas, conversely strong in others.  It is often uninformed by user experience and is too rarely directly applicable.  Moreover, simply presenting evidence and expecting policy makers to act on it is unlikely to work: policy processes are complex, rarely linear or even logical.  It is therefore unsurprising that policy itself can be weakly informed by evidence.

Such a situation cannot be allowed to persist. We need change. It will only be achieved by the adoption of a new paradigm, one in which the use of evidence, open dialogue between users and researchers and one which ensures that users themselves, at all levels, can access evidence which is relevant and effective.  Making use of the best available evidence will mean we can deliver services which are effective, user centred and improve the lives of older people.

I welcome the initiative to deliver a Centre of Excellence on ‘Ageing Better’. Age UK is in a privileged position to influence many of these processes and we will work with others to ensure that evidence is relevant and of high quality, reaches those who need it the most, and delivers the impact we need to improve the lives of those in later life.

Read more about the creation of an independent centre for Ageing Bette

Find out more about ageing issues 

13 responses to “Wising up to what works

  1. A realistic look at a real situation.
    However,I feel,and hope,that the future 85 plus people will have learned to take responsibility for their own health,that they will learn to respect the bodies they have,especially if they were blessed with a healthy and sound body
    I also believe that there will be less reliance on “quick fixes” especially in eating habits and that a wholesome way of life will become the norm.
    We might see centres for people to learn and practice well balanced life styles . These centres would be much cheaper than the present clinics where medicines are distributed .

  2. I hope your right about future over 85 year olds looking after themselves their whole lives.though i doubt it will be so. not because they dont want to BUT…… few of those who now rely on drs/hospitals/state pension were in a position to look after themselves .post war years and after. smoking was the norm. encouraged not frowned upon.food was scarce. they ate what they could muster up from the meagre rations… the future OAPs are now in their 30s/40s or older. those living today in this country of austerity where so many are finding it hard to make ends meet. on the streets having to make do with whatever they can find to put in their bellies. no chance of putting money into a pension fund…that may or may not pay out when they reach pension age.if there is a pension age by then.. these are the ones who, even if they HAVE a job, could very well find themselves without. only today, Walkers crisps owners have announced they are closing their factories here in the UK and taking their business to another country. so how many more are going to be out of a job here?another load on the dole. how are people expected to LOOK AFTER themselves under all these austerity measures which, from what i have read are even worse than during and post WW2 ? and we are told we may get at least another 5 years of this……..if i know anything it will take a lifetime for some people to get through and get over this. a lot wont as the massive suicide and death figures due to medical assessments getting it wrong, show us.
    We older people (I am 70) although so far have escaped most of the austerity measures put in place by this government, are still finding we have to help our grown up children/grandchildren in an effort to see they are clothed,fed and keep their roof over their heads. not easy when on state pension only.
    so how future 85 year olds are going to be able to afford to look after themselves i dont know. i was active. was a nurse for 11 years. was never still.walked miles as i walked everywhere all my life and cycled too in my late 40s-mid 50s which was about the time i started getting things wrong with me. spondylosis & asthma.. right up to about 8 years ago. that was when my body started really giving up on me. as everyone’s does at some point. lucky are those who remain fit into their 60s never mind 80s.no matter what you do you cannot stop the ageing process. no matter what you eat. giving up smoking can help a little. but mot many will afford to do that much longer anyway.
    just my observations and opinions.

    • I have felt all the things you put so very well. I am one of those who are now one of the over 80’s I have just celebrated my 87th birthday and I have,I realise been blessed beyond measure. I was one of 9 children and my father was a coal miner so I certainly did not have a priveleged background and although I was never hungry it was often a close call especially just after WW2
      I remain without medication and with my original moving parts and I do not know how to explain that a younger sister aged 70 died last year from cancer and I am stillhere. She lived an exemplary life and was tap dancing at 65. These are mysteries for which,often,there seems to be no explanation.
      However,you are right and education can be part of the answer and I still hold that Government
      should provide the education and the means to exercise and eat cheaply and sensibly and set up Keet Well Clinics for free to this generation who will,one day also be 87 and 90 and yet live a life with,as they say, decent quality.
      Government does have a responsibility to educate the people in doing the best they can to live out a good long life.

  3. When you have seen the Ageism suffered by someone who is STILL WORKING FULL TIME at 85, in an NHS hospital, you will appreciate that what is needed is the complete removal of ‘geriatric medicine’ from the agenda….age is now a ‘protected characteristic’…thus medicine should be addressing medical problems as medical problems that are perceived as being ‘mainly associated with age’. People who need e.g. hip transplants, need hip transplants – they are of all ages. Ditto ‘arthritis’, ditto ‘dementia’…..these are not ‘age related conditions’, they affect all people. Likewise Downs syndrome adults do not ALL have heart malformations…yet are automatically DNARED on admission to an NHS hospital nowadays – people who have heart malformations do not all have Downs syndrome. The age bias in GSF decisions that people are ‘within the last year of their life’, and in liverpool care pathway decisions not to actively treat alone are obvious, but Age Concern appear to find that acceptable. To watch someone who started work at 14, has paid full tax and NI for an additional 20 years over the average person being ‘assumed ‘ to have a low quality of life (!!) or being told they are not suitable for active treatment, and will only get ‘palliative care’ , simply because they are 85 is adisgrace to the Human Rights Act.
    What is ‘geriatric medicine’ itself, apart from a statement of Ageism?

    • Some very sound points here and one swhich I had not thought of being rather of a positive and hopeful nature. That is not to say,Mark,that you are not! Of course,these conditions are not ALLWAYS related to age and I feel ashamed I did not recognise that
      Thank you for givingme a new perspective on this concern

  4. people of all ages are disabled, people of all ages need cataract operations, people of all ages are deaf, people of all ages have dementia, etc etc etc…..medicine should focus on the medical condition, as ‘age’ is clearly not the CAUSE of any of them….

  5. i agree that a lot of what you say is right Mark and appreciate that but there is a natural decline that our ageing bodies go through or so we have always been told………. are you now saying there is no such thing as actual decline in old age? that certain parts of our bodies dont wear out?cos if so i wish you would talk to certain people i know. (i get fed up of being told its just your age ill admit)

  6. It’s incontrovertible that our bodies deteriorate physiologically as we age, and although this may not be a direct cause of disease it makes us more vulnerable to it, with the result that the older population has more illness and disability than the younger population. Personally I would like to see scarce research resources diverted to understanding and intervening in this deterioration. When you look at the research papers being produced by academic centers which are focused on ageing you find quite a high proportion are concerned with social and mental aspects, and these are well meaning and sometimes very useful. However, when we improve someones physical condition this will often automatically improve there social circumstances, whereas if we instead use our resources to improve their social circumstance this is less effective in improving their physical condition, which, without intervention generally worsens over time. Naturally, as a society we must try to do both but resources will always be finite and to my mind the balance should be towards seeking the concrete measurable benefits that fundamental medical research into the ageing process can bring.

    • i couldn’t agree more. and although,as you say, a lot of the help out there is useful in some cases and well meaning, at no time has anyone asked me,for instance, what I,as an older person,feel I need. for instance, 5 years ago i was hospitalised for 6 days. on coming out was told not to walk but to keep my feet elevated till the ankle swelling went down (i realised very quickly this was due to meds they had put me on) .of course it wasn’t going to because of the meds but did go down somewhat if i disobeyed and walked on them. (supermarket with my daughter…. down almost fully by time i had done.). but because of the emergency that landed me in hospital, i lost confidence. wanted to get it back but couldn’t. now cant go anywhere without my daughter but she hates going places i like to go so its reduced to shopping…hate spending my money on taxis etc but only way i can get to town due to spinal spondylosis. what i would give for someone with a car to pick me up and take me to the park to feed the ducks, or a longer run into the country. etc etc.i would pay petrol / diesel of course. but cant even get anyone suitable to just walk with me often enough to keep me from stiffening up.the last one would walk on ahead chattering all the time not even realising i wasn’t with her.i would be stood ,or sat on a wall if one was nearby, waiting for her to realise i wasn’t there while i got my breath back. (asthma and COPD didn’t help there either)…day centres are no good if your not the sociable type. (I hate crowds as i miss nuances so lose the gist of a convo unless its a one to one.
      anyway just my 2 pennyworth.

  7. To Hugo’s Mum,
    Have you asked your local Age UK befriending service for support?
    To be cut off from little harmless pleasures like feeding the ducks is hard. Yet there are many organisations who provide this kind of support. Check with your Local Authority to see what is out there.

    • yes that is where the last befriender came from but i felt i was the one looking after her to be honest.epileptic, no consistency. so some weeks i didn’t see her at all. there was a gap of 5 weeks between her 2nd and last visit.and it was that last one where she walked so fast i couldn’t keep up with her. completely oblivious to the fact i was no longer beside her.must have gone about 25-30 yards at least (not much good at guessing distances im afraid) before she looked to see where i was.i was sitting on one of those concrete post things. think they are something to do with gas or something.
      after i told age UK i couldn’t cope with that, they kept me on their books for a few months but nothing else materialised. then my nephew started taking me out. i paid fuel costs as he was doing the driving.. we had a lovely year, WHEN he wasn’t in hospital. hes a kidney patient on.3 x a week dialysis. we saw castles, countryside, coast. a wildlife zoo, seal sanctuary. was great. but now i cant afford so much for fuel. plus his life has altered somewhat due to a lot of things. so trips like that on a regular basis where i got fresh air and a bit of exercise plus brain food too at the end of the drive, plus saw places i hadn’t seen before,are not going to take place for some time to come. if at all. so its back to square one for me. at a time when i can do even less than i could before. am now 2 years older and a lot has happened in that time. so parks with ducks, are probably as much as ill manage now if no transport. it used to cost me £14 return to take my dog in a taxi there. but now its more like £18 return.and i can no longer struggle to get him in the nylon carrier. taking him there in his plastic one is not an option. would be far too much for me to cart with me.. plus wont go on my own anyway.
      anyway. will be sometime now i guess before ill be able to afford a taxi to get anywhere other than that which is necessary
      local authority??? their idea of looking after the elderly is day centres and lunch clubs. no thank you. i can dso my own hobby here at home. done al the thinks lke needlework, basket making etc in my lifetime.no more of that. im not a good mixer anyway.would hate both those things..

  8. Well Hugo’s Mum,
    You do seem to draw some bad cards from the pack of life.
    However, one has to keep on trying. That was a MOST unfortunate case with your Age Concern befriender and I am astonished someone with such problems themselves was sent to you.

    I gather that you were a Nurse. Now I do know the Nursing Association has schemes for ex nurses and indeed there are many organisations,who are little heard of but who do amazing good work in communities. why not look into that?

    If you are not a good mixer then that in itself will be part of your problem.
    Maybe you could try to be more of a mixer?

  9. yes i too couldnt believe that they sent someone with so many problems herself. maybe thinking as i was an ex nurse i could cope better than most with her problems. unfortunately, thats why i am an EX nurse. and also the reason why i asked about having a befriender…. i was the one for once, needing some help.
    as for mixing more. not an option. if i cant afford taxis to get to the park etc. how will i afford to get to anything else? buses arent an option now. not on my own especially. besides which, what exactly am i supposed to do to enable me to mix more? in the last 16 years since i left my friends, ppl i had met thru work and volunteering and remained friends with, all behind down south,when i moved back north to be near family, the only friends i made after that was online in chat rooms.all live in various parts of the country. and i used to visit them by coach. but then it got so those things set in place to help disabled ppl with luggage etc.when changing coaches etc stopped being there even though had been organised beforehand. i couldnt carry it myself so my trips had to stop.my last one was about 7 years ago.
    its very difficult making new friends when not in work, kids grown up, grandkids not near you. so no playground friendships. and please dont mention derby n joan./ i do not play bingo. and thats all they offer near me.
    anyway. this whole thing is not about me. its about OAPs in general and the fact that they are not consulted as to what THEY feel they need. not what under pension age people THINK the elderly need. when they renovated these bungalows 4 years ago. none of us oldies was consulted on what we felt would work for us. instead it was designed by 20 odd year olds barely out of uni. had a right fight with the one designing? (thats a laugh) my kitchen over the height of my table top cooker. bought because i could not bend and safely take out a hot dish of something from the conventional oven i had had.
    she said EU said we had to have hobs level with kitchen worktops. i said no good to me. i had a free standing hob. that sat on the work top. i needed the oven in a place where i could safely take things out of it. would have been too low in the place she wanted it. “but you wont reach in the pans” she said………. she came up to my shoulder. barely 5 foot she was to my 5 foot 6. social services helped me but still had to compromise and have it half and half. so again. my real needs were not taken into consideration… that was just an example by the way.(I can only go by whats happened in my life or those i know so use those as examples)

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