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The New Agenda on Ageing

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The New Agenda on Ageing The New Agenda on Ageing To Make Ireland the Best Country to Grow Old In The New Agenda on Ageing To Make Ireland the Best Country to Grow Old In Published by; Ageing Well Network, 16-17 College Green, Dublin. ©2012 Email; [email protected] Cover photo; Shutterstock.com Graphic Design and Production; Anita O Sullivan Email; [email protected] This report is available online at www.ageingwellnetwork.ie The New Agenda on Ageing Sinead Shannon, Research Manager, Ageing Well Network Contributors Health: John Church (Chair); RoseAnne Kenny; Mo Flynn; Cillian Twomey; Hannah McGee; Maurice O’Connell; Patricia Hallahan; Rodd Bond; Brian MacCraith; Eugene Murray; Des O’Neill Income; Brendan Whelan (Chair); Alice O’Flynn; Paul Sweeney; Robin Webster; Brendan Kennedy; Donal de Buitleir; Brian Duncan Engagement; Maureen Kavanagh (Chair); Miriam McKenna; Cillian Twomey; Louise Richardson; Maurice O’Connell; Robin Webster; Gerard Quinn; Gerard O’Neill; Mary Nally Home; Mo Flynn, (Chair), Louise Richardson, Maurice O’Connell, Suzanne Cahill, Enda Egan, Rodd Bond, Siobhan Barron, John McCarthy, Tadhg Daly Age Friendly Communities; Conn Murray (Chair); Andy Cullen; Miriam McKenna; Louise Richardson; John McCarthy; Maureen Kavanagh; Enda Egan; Rodd Bond; Siobhan Barron; Louis Harkin; Gerard O’Neill; Mary Doyle; Des O’Neill; Mary Nally; Louis Harkin; Maurice O’Connell; Strategy Development and Implementation; Anne Connolly; RoseAnne Kenny; Mo Flynn; Eoin Gahan; Paul Sweeney; Suzanne Cahill; Maureen Kavanagh; Robin Webster; Brendan Kennedy; Patricia Hallahan; Enda Egan; Noel Usher Message from the Executive Director The projected increase in longevity is a cause of celebration. It represents significant improvements in standards of living, lifestyles and the health and care systems. It must be seen as a very positive development, both for all of us at a personal level as well as for the societies in which we live. However, the agenda on ageing has generally been very negatively depicted. At the individual level it has traditionally been painted as a homogeneous portrait of decline, loss, frailty and dependency. At a societal level it is described as a major problem, with the focus on the challenges for the health, care and pensions systems and on the potential for the projected increases in numbers to bankrupt the economy. The government has committed to introducing a National Positive Ageing Strategy, but why do we need a Strategy for Older People - what exactly is the nature of the problem we are trying to solve? There are three compelling reasons: • Firstly, the quality of life of too many of our older people is poor. This report highlights the many ways in which this is the case, provides evidence of the extent and nature of those problems and explores ways in which they can be addressed. • Secondly, the scale of the projected increase in the number of older people will require long-term planning to ensure that we have the systems, structures and supports that address the challenges of health, care and income security, while ‘exploiting’ fully the demographic dividend’. • Thirdly, people reaching the normal age of retirement are, in general, healthy and active. They have a life-time’s wisdom and experience and seek a life of purpose, balanced with leisure, social connections and contribution to the lives of their communities. We need to create a new way of thinking about our later years. We need to create new opportunities and a new language to underpin a whole new approach. This report seeks to provide the evidence for what those changes are - from research, consultations with older people and the views of ‘experts’ in the field. It seeks to use those findings to set out the Key Issues for a National Positive Ageing Strategy. Clearly not all the issues can be addressed in a single strategy but what is clear from a review of the Key Issues is that we need a stronger ‘life-course’ approach. So much that determines the quality of life is determined in our earlier years - our health, our income security, our disposition to be happy and engaged, our rootedness and sense of belonging. The big challenge for all of us is that we arrive into later life, healthy and active. It will be important that the Strategy is backed by strong political and policy commitment to create a strong infrastructure. Implementing a New Agenda on Ageing will require a ‘whole of government’ approach with departments and agencies across health, environment, transport, education, social protection collaborating at both national and local levels with those organisations across public, private and voluntary sectors who have a key role to play in implementing a new approach. Anne Connolly, AWN Executive Director. Foreword When the Ageing Well Network was established in 2007 one of the original objectives was the development of a series of Position Papers which would inform the policies and plans of all key agencies in the sector and contribute to the proposed National Positive Ageing Strategy. This objective initially led to the creation of a framework for identifying and communicating the key issues of concern regarding older people’s lives. The model that was developed from this framework the achievement of six targeted outcomes - achieving an Ireland which is a great country to grow old in and in which older people can... • Enjoy an adequate income, free from the fear of poverty • Live in a place that feels like home • Participate as valued members of their own communities • Have access to a good health service responsive to their needs • Live in age friendly communities • Benefit from policies and plans informed by their needs and reliable research To develop this report, members of the Network formed six working groups to contribute their experience and expertise. The meetings of these working groups gave members the opportunity to test and debate ideas, access the latest research and policy developments from Ireland and abroad, influence and be influenced by the cutting-edge thinking of the many different disciplines represented, and together determine best practice in relation to all aspects of ageing and older people. Each working group met three times throughout 2009 and 2010, to contribute to the final report. The significance of this report lies in the fact that it combines evidence of best practice from international and national literature with the knowledge and experience of the Network members. It brings together the high-level critical issues and strategic challenges identified in each area. Based on the latest research and knowledge, the report sets out the options for addressing them, and the likely implications of pursuing different strategies. It does not advocate for particular positions, but is intended to support government and other high-level decision-making by providing evidence on the nature and extent of those issues, clarifying and exploring the range of options available, and the likely outcomes of each. The report is offered as a resource to all those who wish to know more about the issues facing our population as it ages. We would like to acknowledge the vision of our funders the Atlantic Philanthropies and the commitment of our members who gave generously of their time and experience to develop the ideas and themes contained in this report. Contents Executive Summary 13 Chapter 1 Introduction 27 1.1 Framework 29 1.2 Policy Context 30 1.3 Positive Ageing 31 1.4 Demographic Change 31 1.4.1 Global Trends 31 1.4.2 Irish Trends 34 1.4.3 Fertility and Mortality Rates 34 1.4.4 Participation in the Workforce 37 1.4.5 Dependency Ratios 38 1.4.6 Economic Impact 39 Chapter 2: Health 43 2.1. Planning for an Ageing Population 44 2.1.1 Health and Chronic Disease Trends 44 2.1.2 Costs and Service Delivery 46 2.1.3 Gerontological Focus of the Health Service 47 2.1.4 Integrated Care 48 2.1.5 Intellectual Disability 50 2.1.6 Assistive Technology and Health 50 2.2 Health Promotion and Preventative Services 52 2.2.1 Promoting Healthy Ageing 52 2.2.2 Health Screening 54 2.2.3 Cost Effectiveness of Health Promotion and Prevention 56 2.3 Non-Communicable Diseases of Older People 57 2.3.1 Dementia 58 2.3.2 Stroke 62 2.3.3 Falls 64 2.3.4 Arthritis 67 2.4 Polypharmacy 69 2.5 Mental Health 71 2.6. Social and Community Health Care 76 2.7. Hospital Care 78 2.7.1 Age Friendly Hospitals 78 2.7.2 Delayed Discharge and Discharge Planning 79 2.7.3 Rehabilitation and Reablement 80 2.7.4 Reform of the System 81 2.8. Nursing Home Care 83 2.8.1 Care Standards 83 2.9 End of Life Care 84 2.9.1 Quality of Care 85 2.9.2 Place of Death 86 2.9.3 Palliative Care 87 2.9.4 Hospice Friendly Hospitals Programme 88 2.9.5 End of Life Decisions 88 2.10. Disability Services and Health Needs 91 2.10.1 Policy and Planning 92 2.10.2 Primary Care for People with Disability 93 2.10.3 Availability of Data 93 Chapter 3: Wealth 97 3.1 Employment of Older Workers 98 3.1.1 Employers Attitudes to Older Workers 98 3.1.2 The Age Friendly Workplace 99 3.1.2 Unemployment among Older People 101 3.1.3 Retirement Legislation 102 3.1.4 Attitudes To Retirement 104 3.2 Older Entrepreneur and Silver Markets 107 3.2.1 Barriers and Facilitators to Entrepreneurial Activity 109 3.2.2 Silver Markets 109 3.3. Economic Contribution of Older People 111 3.3.1 Intergenerational Transfers 111 3.4 Adequate Supports to Protect Against Poverty 112 3.4.1 Poverty Levels 113 3.5 Replacement Income 114 3.5.1 Pension Coverage 114 3.5.2 Dependency Ratios 115 3.5.3 Adequate Level Of Income 116 3.5.4 Pension Reform In Ireland 117 3.5.5 Pension Reform In Other OECD Countries 119 3.5.6 Pension Reform – Alternative Options 120 3.5.7 Security Of Pension Income 120 Chapter 4: Age Friendly Communities 127 4.1 The Global Age Friendly Cities Programme 128 4.1.1 The Age Friendly Counties Programme in Ireland 129 4.2.
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