Ageing in Mexico: Geriatrics in the New World

José Alberto Ávila Funes is Head of the Department of Geriatrics at the National Institute of Medical Science and Nutrition Salvador Zubiran, Mexico City. He Tweets at @geriatriainnsz

A demographic transition featuring an ever increasing life expectancy is occurring across the globe. In contrast to Old World countries where longevity has predominated for centuries, in Mexico it is a relatively new and ongoing phenomenon only evident since the end of the 20th century. By 2050, one third of the Mexican population will be represented by people ≥ 60 years old, with  life expectancies reaching 80 and 85 years for men and women respectively. But what do these statistics mean? Is there more to ageing than just having more old folks walking around?

Ageing: More life or just more years?

Professor Malcolm Jackson is a research scientist and Head of the University of Liverpool Institute of Ageing and Chronic Disease. His particular research interests are in understanding the mechanisms behind loss of skeletal muscle mass and function as we age.  Looking ahead to the University’s public debate on “Ageing: more life or just more years?” he considers the recent dramatic increase in average age in a city such as Liverpool and the major choices we face in the near future.

The 20^th century was marked by a remarkable increase in human life expectancy – to the extent that it is calculated to be increasing at the rate of approximately 5 hours every day in the UK. This is partly the result of scientific advances. Knowledge of the way our bodies work is becoming more and more detailed and scientists are specialising to an extraordinary degree and developing a basic understanding of the processes that cause ageing and of interventions that can potentially have huge impact on the length of our lives.

Japanese lessons on dementia care

Dr Mayumi Hayashi is a Leverhulme early career fellow in the Institute of Gerontology at King’s College London. She discusses the Japanese approach towards dementia care and suggests lessons for the UK.

Last year, the British coalition government emphasised the need to improve dementia care, with David Cameron launching his “challenge on dementia“, which identified three major goals: better health and care, fostering “dementia-friendly” communities, and improved research. Initial successes included a substantial increase in primary care trust funding for dementia care, but subsequent cuts in government spending resulted in reduced funding for the condition. Discussions in Whitehall about finding new, yet cost-effective, initiatives have been informed by Japan’s experience. There, politicians and policy makers have focused on educating the public (even the term “dementia” was outlawed) by recruiting and mobilising volunteer dementia “supporters”, and implementing a new national compulsory long-term care insurance system, offering enhanced services for people with dementia.

The social and economic contribution of our elders

A conference report from the BGS Spring Meeting in Belfast, by Liz Gill.

Another look at the future came from Claire Keating, commissioner for older people in Northern Ireland. “Shed loads of people are having increased longevity and that is a challenge but no-one becomes 80 overnight so it’s a case of planning. And current projections are not set in stone. For instance, we need to treat older people who have bowel cancer now but we also need to get their grandchildren to eat more vegetables so that there aren’t unacceptable levels when they get to that age.

“We get obsessed with money and the pessimistic outlook gets more attention. Yet the latest research shows that when you add up all economic and social contributions and all the taxes and voluntary work, older people make a net contribution to society of £40bn.

European Courts and Old People

Graham Mulley is emeritus professor of elderly care, University of Leeds.

image Gwenaël Piaser

The current issue of Age and Ageing features an original paper on Older Europeans and the European Court of Justice by Israel Doron.  Why should busy geriatricians be interested in legal activities in Europe?

The short answer is that these courts have the potential for championing old people’s human and legal rights.  These courts often judge in favour of elders, yet the number of cases referred is small and is not increasing – despite the greater numbers of elderly citizens.

Digital inclusion and older people

Emma Solomon OBE is Managing Director of Digital Unite, an independent organisation that helps people, particularly older people, to understand and use computers, the internet and other digital technology.

image by southerntabitha

Having the skills to use digital technology is a must-have in today’s modern society. It can save us time and money, make us feel better connected, less lonely and better informed.

For the citizen as a patient, having digital skills means being able to book and cancel doctors’ appointments more easily, order repeat prescriptions, improve the access to information and services to support their own care and that of others.

By 2015, the NHS Commissioning Board aims to guarantee every patient the opportunity of online access to their own medical records. This is an ambitious target made even more challenging because today in 2013, many older people still either aren’t online or don’t have good enough digital skills to use such a service.

Age and Ageing collection: The Recruitment of Older People to Research

Prof Gordon Wilcock is Vice President for Academic Affairs at the British Geriatrics Society, is Emeritus Professor of Geratology, University of Oxford.

A collection of 10 Age and Ageing papers is free to view on the journal website.

Concern has been expressed for a long while about the lack of older people included in clinical trials. However, the inclusion of older people in research in general is a subject worthy of attention. There are many reasons why it is sometimes difficult to recruit people over 70 into research. Some of these are self-evident, e.g. the presence of co-morbidities leading to travel difficulties, reluctance to take on something that may be onerous, cultural divisions, language barriers, research skills capacity, a greater risk of ill health, and the reluctance of family members to support an elderly relative in a research project.

The Relationship Between Wealth and Frailty

Prof Kenneth Rockwood is Director of Geriatric Medicine Research at Dalhousie University, Canada and serves on the International Advisory Panel of Age and Ageing journal.

It’s never good to be frail, but it’s worse to be frail and poor, or to be frail in a tough environment. That would be one conclusion from a recent analysis of data from middle-aged and older adults in the Study of Health, Ageing and Retirement in Europe (SHARE). This analysis (by our group) showed that the number of health problems people have (the mean deficit count in a frailty index) was strongly and negatively correlated with national wealth (measured by Gross Domestic Product – GDP). In fact, for the 15 countries evaluated, per capita GDP “explained” about 60% of the variance in the national level of frailty.

Debate:- Funding social care for older people- The Gathering Storm

The question of how to best fund care of frailer older people in their latter years remains unresolved. Current rules require all older people with assets above £23,250 to personally fund all care requirements and all assets [including property] are included in financial assessments. The arrangements have been criticised by many for forcing those who have worked hard to build assets through their life to

In the past 13 years there had been two independent commissions, three public consultations and now three white papers. The latest of these, the Dilnot report, called for a system for the elderly whereby there was universal coverage: the total cost of care would be capped at £35,000 with social support for old people extended to those with assets of £100,000, incurring a total estimated cost of £4.2 billion in 2025.

The social care issue is thorny and has multiple facets:-

• Can we afford it? – the present economic climate brings to harsh reality the ability of the welfare state model to provide for all aspects of life on limited resources
• Who should fund it? – the government, families or the third sector
• Universal coverage? – Should any legislation cover all people without any exclusions or prejudice? What happens to those, with financial means, who do not wish to contribute to their own care?
• Financial fairness? – What is “fair”?  Who should pay? How much should they pay?
• Equity of provision across the UK? – How do we minimise variability in how legislation and policies are exercised between regions?

What are your views on funding for long term care? Join the debate.

One in three babies born in 2012 will live to reach 100

One of the perennials I get asked to comment on as a geriatrician are Office of National Statistics population projections and what they mean for geriatricians, older people, older patients and the population as a whole.

The most recent ONS paper to draw attention can be found here.

The headline statistic from this – one in three babies born in 2012 will live to see their 100th birthday – was sufficiently compelling to attract the attention of the lay media.

The Telegraph focussed on the financial challenges of providing pensions for the expanding cohort of octo- and nonagenarians.

The Scotsman took a more equivocal stance, worrying about the impact on the health service, whilst also praising the achievements in public health and healthcare underpinning the ever increasing life expectancy.

I was asked to appear on BBC Radio Nottingham to comment on this today (available for 6 days). Before the interview they played a “vox pop” of people on the high street. A consensus was evident, that quantity of life was desirable but only if it came with some quality of life. The challenge for us as geriatricians, as we attempt (and at times struggle) to support a rapidly expanding number of patients with dementia (cf: the National Dementia Strategy) and in care homes (cf: Quest for Quality), is to keep this objective firmly centre-stage.