Health and Wellbeing Report
Provocation – The Future of Old Age
Professor Tallis centred on the future of old age, looking at four areas: Physical dependency, cognitive impairment, financial dependency and social exclusion. Outlining his own position, he quipped with the rest of the group that he only started using email without the help of his secretary in 2003, and is himself a good test case for the elderly population.
The provocation began with a survey of how the population is changing in terms of age, mortality and life expectancy. Starting by explaining the increase in the rate of life expectancy, Professor Tallis confirmed the fact that in 2011 “there are already many more older people” and called for a fundamental change in the thinking towards the whole course of life – using the term “the third age”[ii] to describe people who are in their senior years but without any significant onset of illness. He explained that one of the key factors contributing to the increase in life expectancy has been the decline in infant mortality and improvements in preventing disease. For example, cardiovascular disease fell by 30% between 1968 and 2006 and deaths from coronary heart disease in people younger that 65 have fallen by 46% in the last 10 years[iii]. He said that, “life expectancy is increasing at a rate of about two years for every decade that passes”[iv]. Further he explained that we have “a great difficulty getting our heads around what is happening now with ageing,” because the ways we though about it have remained almost the same from “the time of Charlemagne (8th Century) to the middle of the 1800’s!” He went on to suggest that it is crucial to consider “what sort of ‘nic’ you are going to be in” when you reach your latter years because of the projected burden to the healthcare and social care system.
Four Scenarios for the Future of Old Age
Professor Tallis outlined four different projections for the future of old age, using the term ‘woe’ as an indicator of ill health or declining health:
- 1 year of additional woe for every year of life gained;
- Less than 1 year of additional woe for every year of life gained;
- No additional woe for each year of life gained;
- Less woe despite life gained – known as the Fries Compression of Morbidity Model.
Suggesting that the last scenario appears to be occurring in some places and “is possible in all places…” he went on to say that, “it is not a biological impossibility” that people live longer and are ill for less time. He explained that he could see a scenario where there was “significant gain in life expectancy and greater gain in healthy life expectancy”. In particular the longer people are healthy the better, because it is simply not possible to care for a growing ageing population that is unhealthy, indeed it is, “cheaper to keep old people in good nic!”
Dispelling the myth that “we can’t afford to keep old people healthy”, Professor Tallis explained that this idea assumes that old people are consumers and not producers. Given that ‘old age’ is social construct as well as a biological phenomenon, he suggested how it might be possible to solve issues around increased burden on pensions by “pegging the median age of compulsory retirement to the median age of death”. As such, he suggested that this is all “a matter of sums!” Importantly, this outlook does not necessarily depend on major medical breakthroughs but instead on social inclusion and technology, which “is absolutely crucial because increasingly, social inclusion is being mediated through technology”.
Professor Tallis explained how that e-literacy can bring older people “into the conversation,” and how computer technology is “absolutely essential” to achieving this. He went further to assert that it is vital for older people to be able to navigate an increasingly electronic collective reality. He also suggested that whilst there has already been lots of work in the area of technological assistance for old people that this will, of course, only increase and will have a particularly important relevance for people with cognitive impairment. Lastly, he talked about the delivery of medical monitoring and care through tele-care, as an example for the future of health and well being.
In addition to technological solutions Professor Tallis also outlined the importance of the arts and human to human contact for older people, through practices such as dance, music, poetry, reading groups and the University of the Third Age. In this context, he also went on to express some of his concerns about technological developments by suggesting how important it was that, “hands on care is delivered by a sentient human being who is full of human sensitivity and compassion,” leading to what would become a cornerstone phrase of the debate – “you can get a machine to wash your bottom – but it depends on how the bottom is washed!”
