You’re Looking Very Well

outcomes. However, free influenza immunisation is being offered to everyone aged 65 and over, and routine breast cancer screening is being extended to women up to and including the age of 70.

A study in Newcastle of 85-year-olds gave a positive set of results for medical care by the NHS. Almost one third of the sample had attended outpatient clinics in the three months before the study. In the previous year, 20 per cent had had at least one overnight stay in hospital, spending, on average, seven days in total over the stays. Almost all of the sample had seen their general practitioner within the past year. Perhaps the most striking findings were the low levels of disability of people living in institutional care, and positive self-rated health despite high levels of disease and impairment. Although women were more likely to survive to age 85, they were more likely to be living in institutional care, to have a higher total disease count and higher prevalence of many diseases.

A three-month undercover investigation at Brighton’s Royal Sussex County Hospital by the BBC’s Panorama showed how hospital care can fail the elderly. In one scene a patient is left to die on her own; another patient is left waiting hours to go to the toilet; another was left screaming with pain as she had not been give her medication for hours. Margaret Haywood, a nurse with more than 20 years’ experience, agreed to go undercover for the Panorama programme, wearing a hidden camera while working as a nurse to fill a short-staffed ward at the hospital for 28 shifts on an acute medical ward. She found that none of the patients had a care plan. She was then struck off from working as a nurse, but this was later reduced to a one-year caution.

An environmental factor, cold, has been responsible for the deaths of many old people in their homes. The average energy bill has increased by 80 per cent since January 2003‚ and an energy bill of ?1‚027 would absorb 16 per cent of the income of a single pensioner. In the winter of 2004/5‚ more than 30,000 people over 65 died from cold-related illnesses in England and Wales, and there were some 16,000 excess winter deaths among the over-75s. Because nearly half of pensioners will cut heating in winter for financial reasons, some 5 million over 60 will get cold shock. The UK has a higher number of winter deaths than in colder European countries, despite the government’s winter fuel payments.

It is very unusual for the cold to kill people directly, and in the main these deaths are from respiratory or cardiovascular ailments. Deaths may also result from heart attacks‚ strokes‚ and bronchial and other conditions‚ and may often occur several days after exposure to the cold. The elderly are more vulnerable because of various illnesses and of course, the failure to warm their homes. Age Concern estimated that 250‚000 older households have been pushed into fuel poverty by price hikes. Many pensioners have to choose between eating or heating.

Paul Cann‚ from the new united charity Age UK, says:

To deliver consistent and decent quality healthcare for older people‚ dignity must be at the heart of the NHS Reform Bill. On every occasion and in every health setting‚ older people should be alleviated from discomfort and pain‚ given help to make choices and treated as individuals not numbers.

13. Adapting

‘The tragedy of old age is not that one is old, but that one is young’

— Oscar Wilde

Men and women in the developed world typically live longer now than they did throughout history, an increase from about 25 years 2,000 years ago to around 80 at the beginning of the twenty-first century. The increase has been mainly due to the advances in medicine and biology which have given us vaccines and antibiotics, and the development of sanitation systems, as well as better lifestyles and better nutrition. All of these have been successful in preventing infectious and parasitic diseases causing premature deaths. But we now need to understand the implications of the increase in age of the population.

At present just 11 per cent of the world’s population are over 60, but in developed countries they will be one third of the population by 2050. In rich countries one in three individuals will be pensioners and one in 10 over 80. In some countries in the West the over 65s are the fastest growing age group. Those over 80 in the world are expected to increase to 4 per cent by 2050, four times more than now. Current estimates are that 700,000 of those in the UK at present around 25 years old will live to be a hundred. Moreover, half of babies being born now will reach a hundred thanks to higher living standards. But our bodies are still wearing out. Children will be outnumbered by those over 75 in what some call the Zimmer-frame society. How will society adapt?

A majority view is that an increase in numbers of older people would make no difference to safety, security, standards of living, health or access to jobs and education. But one third of the public think life would be worsened by an increase in the older population because it would have negative economic effects. It is worth noting that by 2050 it is estimated that more than one third of voters in the UK will be over 65, and since the old vote more than the young, they could wield much power and vote for much costly support in their old age.

David Willetts, the current science and education minister, has argued that the baby boom of 1945–65 produced the biggest, richest generation that Britain has ever known. Today, at the peak of their power and wealth, baby boomers, he claims, run our country; by virtue of their sheer demographic power, they have fashioned the world around them in a way that meets all of their housing, healthcare and financial needs at the expense of their children. Social, cultural and economic provision has been made for this reigning section of society, whilst the needs of the next generation have taken a back seat. But it is the old who will have the greatest impact.

Some analyses suggest that improvements in health and longevity have resulted in enormous gains in economic welfare. One estimate of the economic impact of post-1970 gains in life expectancy suggested that they might have added as much as 50 per cent to the GDP of the US. Even so, there are profound economic problems to be tackled.

The Economist has called the economic effect of an ageing population a slow- burning fuse. It claims that age-related spending by a country like the UK will in the future be more serious than the recent recession. The elderly require money for pensions, health and care. The age-related spending by the government in the UK is already about ?7 billion, less than 1 per cent of GDP, but it clearly needs to rise. Already there are billions of pounds of benefits for the old which are not claimed. The last years of life can cost tens of thousands of pounds and this increases with advanced age. In many cases the cost of the last year of life is more than all that has been spent in earlier years. Forcing older workers to retire cost the UK in 2009 an estimated ?3.5 billion in lost economic output. Pension plans, social security schemes and notions of the length of working lives will need to undergo major reformulation.

The small increases over time in average life expectancy that lead to very large increases in the size of a population are prompting many arguments. Reproductive practices might have to change in order to keep the population from becoming too large. In regard to the escalating costs of looking after the old, one group in the US has suggested there should be cuts to protect the young. It has been argued that any technological advances in life extension must be equitably distributed and not restricted to a privileged few. There are suggestions that the UK will become a giant residential home, with the young looking after the old. With family ties weakened by increased mobility and rising divorce, in the future the elderly will be less likely to be married or co-habiting, and more will live alone; and since they do not want to leave their homes it will hard for the young to find one to buy.

Such concerns were presented by Jeremy Lawrence, writing in the Independent, who described the ageing population as the greatest threat to human society: ‘No invading army, volcanic eruption or yet undreamt of plague can rival ageing in the breadth or depth of its impact on society… The impact of this transformation will be felt in every area of life, including economic growth, labour markets, taxation, the transfer of property, health, family composition, housing and migration. And the “demographic agequake” is already under way.’

The countries with the oldest populations—that is with the highest percentage over 65—are Monaco, then Italy and then Japan. The median age of the world population will, in the next 40 years, go from 28 to 38. The United States is on the brink of a longevity revolution. The elderly comprise 12 per cent of the US population, and their number is projected to almost double between 2005 and 2030, from 37 million to 70 million. By 2030, the