JOINT COMMITTEE ON HEALTH AND CHILDREN debate -
Tuesday, 1 Dec 2009

Positive Ageing Strategy: Discussion with Centre for Ageing Research and Development.

Chairman

We are meeting representatives from the Centre for Ageing Research and Development. I welcome Dr. Roger O'Sullivan and his colleagues from CARDI to the meeting. I draw the attention of witnesses to the fact that members of the committee have absolute privilege but this same privilege does not apply to witnesses appearing before it. Members are advised of the long-standing parliamentary practice to the effect that they should not comment on, criticise or make charges against a person outside the House or an official by name or in such a way as to make him or her identifiable.

We have received a detailed submission from the delegation and appreciate it appearing before us today. Dr. Roger O'Sullivan will make a five minute presentation, after which we will take questions from members. All questions will be taken together and then we will return to the delegation to finish the meeting.

Dr. Roger O’Sullivan

I extend my thanks to the Chairman for inviting CARDI to present our work and highlight the important issues relating to our aging population. I am joined by CARDI's co-chairs, Professor David Coakely, consultant geriatrician at St. James's Hospital and professor of medical gerontology at Trinity College Dublin and Professor Bob Stout, emeritus professor of geriatric medicine at Queen's University, Belfast. I will provide some background information on population change in Ireland and the work of the Centre for Ageing Research and Development in Ireland, CARDI, as well as the central role of research in informing the positive ageing strategy.

We live in a time of demographic change. Ireland's population is ageing. Today, people aged 65 and over make up 11.1% of the population of Ireland. It is expected that this will increase to 23% by 2031. The largest increase is in the older old. There are now 48,000 people aged 85 and above. This number is expected to triple by the same date. It is a sign of achievement that we are living longer than ever before but while life expectancy has increased, it is not clear that life without disability and ill health has increased to the same extent. The incidence of disability rises sharply with age. For example, just under 30% of people aged 65 and above have a disability compared with 9.3% of all ages.

Of the 160,000 carers in Ireland, over 18,000 are aged 65 and above. The average age of a carer of an older person in Ireland is 73. The challenge is to ensure that a growing number of older people will not face the combined effects of a decline in physical and mental function, isolation and poverty. Likewise the important contribution of older people to families, communities and the economy cannot be understated.

Against this backdrop, CARDI, a not-for-profit organisation, was developed by leaders from the field of ageing across Ireland North and South. It was launched in 2008 by the then Minister of State at the Department of Health and Children, Deputy Hoctor, and junior Ministers Kelly and Donaldson from the Office of the First and Deputy First Ministers in Northern Ireland. Our focus is to help research play its part in improving the quality of life of an ever-increasing number of older people in Ireland, North and South. Rather than undertake research, CARDI focuses on bringing together the research community and relevant players from Government, the voluntary and community sectors and older people so that those with the skills and knowledge of ageing can concentrate on the top research priorities.

CARDI welcomes the development of a national positive ageing strategy and the recognition that older people are central to its development. We also welcome the concept of positive ageing which embraces several factors, including health, financial security, independence, personal safety and security, and the built and physical environment. The contribution of older people to economies and communities is becoming increasingly important, as are their demands as consumers, and their expectations as citizens. These needs must be understood and addressed effectively. CARDI recognises that governments need sound, credible and informed policy-focused research to help ensure that policies can respond to this change.

In response to the national positive ageing strategy, CARDI recommends the development of a linked research strategy. This will help ensure that ageing research is seen as a central and underpinning function in the planning of high quality services and related policy for older people in Ireland now and in the future. An ageing population provides an opportunity for research in a wide variety of areas, not just in health and social care but engineering, technology, housing, transport and economics among others. CARDI believes that to be most effective greater cross-sectoral and interdisciplinary collaboration and co-operation will be required across the island of Ireland.

The transition to an ageing society requires that effective energy and resources are directed towards planning. Failure to plan for changing demographics will hurt the most vulnerable in society. The recession brings to the fore many concerns such as pensions, public services and transport but also provides an opportunity for the research community to play its role in helping to make the best of existing resources.

This committee has an important position in respect of the national positive ageing strategy by ensuring that the evidence base is central to allow for policies and services to be designed to meet the needs of older people.

It is a sign of success that we are living longer and the challenge is to ensure that people stay healthy and happy for as long as possible. We acknowledge the committee's interest in this issue and thank it for listening. We hope it found this presentation informative.

Deputy James Reilly

I do not have questions but observations. I thank the representatives of CARDI for coming to this meeting. This is a very important area. Professor Des O'Neill got it right when he said let us not talk about "older people" but about ourselves as we grow older. That is a strong message that needs to be put out.

The important work of Charles Nolan showed that the last ten days of one's life are the most expensive for the State but that it costs three times more if one dies in one's 50s or 60s than if one dies in one's 70s, 80s or 90s. It is exciting, a word I do not use often, that groups of individuals with a specialist interest in this area are coming together under the aegis of CARDI to encourage the sharing of information which will inform how we go about providing facilities for communities as we grow older and the needs of the older person, or ourselves as we grow older.

There are many issues we could discuss but this is not the appropriate place to do so. I might communicate directly with CARDI. I do not intend this as a political argument but Professor O'Neill's work on the well-being brought about by the medical card, which is to be withdrawn, was an unexpected effect about which we would not have known without the research to show it.

Senator Phil Prendergast

I am delighted to be here to welcome CARDI and to thank it for its very comprehensive submission. I am very interested to learn that there are 468,000 over the age of 65 in Ireland. I am the Labour Party spokesperson on older people. The party is examining an initiative to find out their numbers and needs and to eradicate the stereotype that society has of older people. Using research and international best practice produced by the Oxford Institute of Ageing and other internationally-recognised agencies, as well as the new group in Limerick, DG SANCO and other agencies, we can look forward to getting the best for our ageing population and offer it something real.

I look forward to assimilating all the information CARDI has provided and to communicating with it again. We must be realistic in defining our policies. This is one of the most interesting presentations I have witnessed.

Senator Mary M. White

I thank Dr. O'Sullivan for his presentation. He is speaking to the converted because I produced a policy document on ageing and ageism three years ago in which I quoted Professor Des O'Neill who gave me tremendous help.

Next Monday I am also launching an all-Ireland inspirational life award which will have three categories: a person who has gone beyond traditional retirement age and is living a full life; a person of any age who is working to help enhance the life of older people; and any company, private, public or voluntary which is working to enhance the life of older people.

I am working with Dame Joan Harbison and Ann O'Reilly from Age Concern and Help the Aged, both in Northern Ireland, to effect a serious cultural change in people's attitude to older people. One example is discriminatory compulsory retirement at the age of 60 or 65. The most blatant discrimination is having to retire at 60 or 65 years of age. One of my adjudicators on this side is Martin Donnellan. He was a Garda Assistant Commissioner and took a case to the High Court last year because he did not want to retire at 60. He did not win his case but he is receiving half of his salary as a pension when he wants to work. He would work for half of his salary because he did not want to give up his job. His pension is half of his salary and he is not utilising his skills.

This is the final acceptable prejudice, with a stereotype that a person, when he or she hits a certain age, can no longer be included. Politicians can be elected to the Oireachtas at any age as long as the public elects them. There is legislation, however, to stop someone from working past 65.

We are launching our campaign on Monday and we have three major sponsors, The Irish Times, Vodafone and BT. Mr. Nicky Brennan, the past president of the GAA is another adjudicator on our side. The GAA has a social initiative to involve older men.

We must tackle ageism, no matter where it happens. There is a life after 65 and the prejudice displayed to people of that age is like chauvinism in the past.

Deputy Dan Neville

I am interested in old age psychiatry and the neglect of services in this area for the elderly who have a psychiatric illness, particularly those who have had such an illness and have moved on from it, who now need geriatric treatment but are placed inappropriately in mental institutions. They should not be there; their needs are for nursing home care, not psychiatric care.

Deputy Margaret Conlon

I also welcome the delegation and thank the witnesses for the presentation and supplementary documentation. This is valuable work. We must see a cultural change and we should start with how young people look at older people in society. People talk about the "auld ones" and nursing homes as "old folks' homes", which are totally inappropriate comments.

As a rural Deputy, one of the most important aspects of my work relates to rural isolation and how elderly people cope with it. As a society, when times were better, people were busier and everyone minded their own business, not bothering with neighbours in the way that would have been the norm in the past. Perhaps we must take a step back to look at the idea of being a good neighbour, calling into people who may be isolated and who might not see anyone all week except the postman. For them, the highlight of the week might be the trip into town to collect their pension and do some shopping. Is there any research into isolation in this area? How might it be tackled?

Older people in society have so much to teach us from their life experience. My own mother-in-law is 93 and my children have been given a wonderful insight into what life was like in her day. They have gained the benefit of her wisdom. The perception that because a person is a certain age, he or she does not have an opinion should be challenged.

For those who have retired, there are better opportunities than was the case previously. There are computer courses for the over 65s, with those on them achieving something wonderful. The groups providing those activities are to be commended but more work needs to be done in this area.

Deputy Kathleen Lynch

I am always conflicted when I hear the notion that there should be a cultural change in our attitude towards people of a certain age. Where I come from, people of a certain age are greatly respected and while they are not in the full flush of youth and perhaps can no longer run a one minute mile, it is recognised that they may need a little extra support.

We should concentrate on the positives of older people. I know people who are old at 40 and others who are young at 70. It is about restrictions that society places on a person and that people place on themselves. I am conflicted also that someone might decide to change the law to tell me that I must work until I am 75. I am not sure which would be worse - to retire at 65 or at 75. I think 75 would be worse because I have a few things to do before I go.

We should be looking at the absence of hope felt by people of a certain age. With support and encouragement, there is no reason that someone of 70 should not go on a skiing holiday. We can replace hips so it is okay. We must change our attitude rather than thinking people should be cocooned because they are old. I know extraordinarily interesting people who are almost 80 with a far more active social life than me. The limits faced by people of a certain age are often self-imposed. The expectation of how a person should behave has a lot to do with it.

Young people suffer from the same prejudices as people at the other end of the scale. Not all young people are bad; in general, they are respectful and caring for those within their family at the other end of the scale. The research will tell us a great deal but we should not find ourselves in a tunnel where the only way out is to wrap people in cotton wool. That might be the answer for some people, but not for all of them.

Deputy Bobby Aylward

I am delighted there is a group like CARDI. A society is judged by the way it treats its children and its elderly. How has Ireland done in recent years? We have the second best social welfare system in Europe so how do we score out of 100? There are backup systems that include carers and medical cards. What does CARDI think of how we are doing? We know there is a back-up system in the form of carers and medical cards but I would like to hear the delegates' views. Given the expected growth in population into the future from 11% to 22% by 2040 and a small workforce of 4.5 million people how can we afford the same level of services into the future?

Like my colleague I would like to speak about rural isolation as I too come from a rural constituency. Have the delegates researched rural isolation especially in view of the violent attacks on older people living alone? If so, perhaps they would comment on how we can get over this problem?

Senator Frances Fitzgerald

I thank the delegates for their presentation. This is a really important and interesting area and there are significant challenges in it in Ireland at present. Obviously people are living longer as a result of huge medical improvements. Older people face significant challenges in terms of accessing medical care and the resources they may need if they have a health problem. There is also the issue of attitudes to aging.

The words "stereotype" and "discrimination" have been used by my colleagues. We still face fairly significant challenges in that area so far as an aging population in Ireland is concerned. Are other initiatives needed to bring together the medical researchers, such as CARDI, and the cultural organisations and Government organisations? There were two commissions on women, for example, when discrimination against women was far more severe than it is today. Do we need an initiative in this area to tease out these issues and have a plan of action and an implementation plan? We have the theory at this stage but I am not sure we have the implementation plan across the different areas.

Chairman

We have quite a broad range of questions for the delegates. Members are very satisfied with the work they do and are encouraged by the presentation made to us. I congratulate them on the work they do. In responding to members questions perhaps they might refer to how well they are resourced to do the work. Professor Stout and Professor Coakley should feel free to join in the responses.

Dr. Roger O’Sullivan

I thank the committee for its interest in our work in CARDI. I will respond to a range of issues and my colleagues will also respond. On the issue of rural, which arose twice, part of our work is to encourage the researchers to work across the island of Ireland but also across disciplines, so that people from a medical background work along with people from a planning background or an economics background, and across sectors with people from Government, academia and the voluntary and community sector. One of our areas of work was a small grants programme to encourage researchers to work across the island of Ireland. One of the areas we support is a project on the theme of healthy aging in rural communities. This involves a researcher from Galway University working with a researcher from Queen's University and rural voluntary organisations in Northern Ireland and the Republic. That is one of the areas we recognise as an important issue. The research is not yet published but there are many common themes around isolation, such as vulnerability and access to services. What is particularly interesting coming from an all-Ireland organisation is how common issues can be dealt with differently both North and South. That report will be available in the latter part of 2010.

On the issue of how Ireland compares to its counterparts, a selection of statistics is provided in the pack which may be useful. The committee will be particularly interested to hear that next month we have a report that compares how we age across the island of Ireland North and South and issues in respect of poverty, pensions, and health and well being. It also makes comparisons in relation to our European counterparts so that will provide full information.

On the issue of older people in society and their relationship with younger people, in 2010 we are working the reminiscence network to try to show the importance of storytelling and the valuable contribution older people make in sharing their experiences. That is an event that will have an all-Ireland perspective where we will share the role of storytelling for health and well-being.

Professor Bob Stout

I will tackle the question of resources which was raised by the Chairman. CARDI is not a research funding body. We have a limited resource which we use to stimulate collaboration and new research areas but major research is beyond our resource. Our aim is to encourage the other funding bodies to produce the funds and to use them for research into aging. It is not a well-funded area. There are no major aging research charities comparable with the cancer charities. It does not stimulate a great deal of public interest or public donation. It comes back to attitudes and many people think aging is inevitable so why the need to research it. They do not realise the potential for improving the older person's life and experience that could come from research. Resource is an issue that needs to be addressed but through the other research funding bodies. Do they allocate sufficient of their funds to research ageing and is there any way the charitable sector could be stimulated to produce funds for research into ageing?

It must be remembered that quite an amount of research which is not labelled 'ageing' could be of benefit to older people. For example, I mentioned cancer. Cancer is most common in older people. Cancer research will benefit older people also. One of the problems about research into aging, is to define what we are talking about. We need more funds in research into ageing and there is potential to do more research if we had more funding.

Professor Davis Coakley

I support that call. The type of funding we are providing is small but it is well targeted. CARDI is not funding major medical research or laboratory research but research into practical problems in the community and groups working out in rural areas or in cities. Deputy Neville raised the issue of old age psychiatry. That area is developing but not as quickly as it should and it needs much support. There are positive signs. Professor Brian Lawlor in Dublin is doing much research in the community on depression and confusion. The whole drive is to maintain people at home as long as possible. The development of community services which will enable that to happen is also very important.

Chairman

Are there any other matters that members wish to raise? We are all happy. I thank the delegates for the work they do and ask them to keep in contact with the committee.

Professor Bob Stout

I thank the committee.

Sitting suspended at 3.48 p.m. and resumed at 3.52 p.m.