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What this series is about … As we age, keeping physically active is essential. It not only improves the appearance of the body, it also prevents the occurrence of health complications in the future. Join the discussion in this series as we research the various programs that can help maintain a healthy mind and body.
Staying Young: Successful Ageing (Part 1)
The last in this series deals with successful ageing. The urgency, now, has begun to shift from that of medically prolonging life to ensuring that a prolonged life is worth living.
Getting older does not just affect us as individuals; it affects our society too. It is important that we as a society do not hold back on government services that could be available to those elderly who are genuinely poor and disadvantaged. The good news is that with age comes dignity, and a greater understanding of life and human conditions.
In fact, a new paradigm is now emerging and researchers are exploring this issue along several fronts. Some of the most practical applicable work has come from the field of humanities and social sciences.
Part 1 of this issue discusses the economic implications of ageing; how we may protect ourselves—age gracefully—and assist the challenges in sustaining health care costs.
Most important to successful ageing is to keep the mind active. The importance of social involvement and leading an intellectually active and socially-involved life cannot be overstated. It is social connectedness. Social connections—whether they come from friends, family, a church community or a job—help fill life with meaning and companionship. The connections between healthy living and healthy ageing are there, but the ability to enjoy the ageing process depends on attitude, willingness and determination to engage and be active. Being engaged (body, mind and spirit) enables us to weather emotional and physical challenges and fully enjoy life.
Cognitive capacity, more than any physical disability, most often determines whether people can attain extreme old age while sustaining a quality of life. Studies in this area range from better understanding of the physiology and biology of ageing to the importance of social support to the basic review of everyday activities. Research is now proving almost daily that memory and cognitive power do not necessarily decline with age as traditionally thought, and humans in their later years have far more physical and mental strength than imagined. This concept gained momentum with study results released by Princeton University in October 1999.
Why? John Cavanaugh, a researcher on ageing issues at the University of North Carolina at Wilmington, believes the answer lies buried in memory and stored as “beliefs”. With memory, it does appear that people’s belief systems are important and the kinds of things people tell themselves to remember.
Research also shows that memory loss can be reversed by personal strategies. Newer methods are being designed to help people modify behaviours, slow the decline of ageing and take advantage of increased longevity.
The importance of exercise, physical activity and balanced nutrition—low in saturated fat, with plenty of greens—is well known to us all. Even if we do all these things, we are bound to lose some of our capacity eventually. There may have to be changes in our personal circumstances. This may mean some alterations in our environment. For example, in the home (adding railings, non-slip surfaces, ramps, or additional lighting), or with walking aids; it might mean calling on community services (community options) for help—home help agencies, home nursing, and meals on wheels—can ease the burden. Or our accommodation may need to be changed—we may need to move to a smaller villa, or a retirement village that provides services such as meals, nursing and medical care.
As we age and become susceptible to degenerative illness the number of medications we take will increase. Sometimes these may interact with each other and contribute to symptoms like mental confusion and feeling weak and faint. So, it is important to check with one’s doctor regularly about possible side effects and whether some medications need to be discontinued.
Research shows that regular mental activity can also reduce the onset of dementia and improve brain functioning in old age. In fact, researchers at Stanford University in USA have found that memory loss can be improved by 30 to 50 per cent simply by doing mental exercises. For example, reading newspapers, magazines and books; developing intellectually stimulating pastimes; playing “thinking” games like scrabble or bridge; taking up a hobby; doing a course or learning a language.
Ageing gracefully tends to make older people happier and more contented with their lives. Over the years, they become more adaptable and they are more likely to accentuate the positive and play down the negative in any given situation. Older people make more time for relationships and for sharing their intellect and skills in various forms of community engagement (e.g. volunteering).
Economic implications of ageing
As we age we contribute a great deal to society in experience and wisdom, but we also cost more than younger people—in health care, in old age pensions, and because of the fact that we are usually retired, and so do not pay as much tax, if any. That is not a problem while there is plenty of revenue coming from younger people who work and pay taxes to support those older people (who, in their day, worked just as hard). But our society is becoming older. As it does, some economists argue that it is going to be harder for governments to be able to sustain those levels of services for the aged. What is worrying, they say, is that over the next 20 to 30 years, the baby boomers (the big increase in Australia's population that came after the Second World War) will move into old age.
According to the Australian Bureau of Statistics (ABS), as the youngest of the baby-boom generation turns 65 in 2031 the proportion of the population aged 65 and over is projected to reach between 21 and 22 per cent—roughly double of what it is now. Social and economic adjustments will occur to accommodate this gradual demographic change.
Aged care costs
Not all costs will increase as our population ages. Some costs, like education and unemployment benefits decrease in a proportion of GDP as people age. But these reductions, so the argument goes, are not enough to compensate for the costs to society of more old age pensions and health care costs.
At the same time, fewer people will be in the workforce. As more people shift into older age groups, the overall workforce participation rate is projected to drop from around 63.5 per cent in 2003-2004 to 55.4 per cent in 2044-2045.
More retirees mean a smaller percentage of workers. And the difference is not being made up by immigration or by more young people coming onto the job market. Furthermore, the reduced fertility rate is also a contributing factor, and hence the recent baby bonus pledge of the government.
Fewer workers either means a greater tax burden on those who are working, or less money available to governments to fund pensions and health care for older people. The challenge, then, is for society to keep up the standard of living and quality of life that citizens deserve when they retire, with less money to pay for it.
Some states will be particularly hard hit because they have older populations and higher unemployment than the rest of the country. According to the ABS, Tasmania's population is projected to age the most rapidly, overtaking South Australia as the “oldest” state in about 20 years, and reaching a median age of around 51 years by 2051. By that year, the proportion of the population aged 65 and over is projected to reach 32 per cent in Tasmania and 29 per cent in South Australia—well above the average of 24 per cent for all of Australia.
According to the Productivity Commission the shortfall is about $50 billion per annum. The Commission’s 2004 report Economic Implications of an Ageing Australia projects the difference between taxes and expenditures that corresponds to 6 to 7 per cent of GDP.
Most of the gap will be because of increases in health care costs. As we age and we suffer the deterioration in our tissues and organs that we have discussed earlier (also in previous issues on this subject)—and especially if we also have degenerative diseases—we will need proportionally more medical services to treat them.
Health costs are already outstripping inflation and annual growth in GDP, thanks to new, sophisticated technologies and more expensive drugs coming on to the market. In addition, there are increasing demands for extra hospital beds, nursing home beds and aged care services that we will continue to need. The Productivity Commission report indicates that there will be an increase in the percentage of GDP spent on health from current levels of seven per cent to about 11 per cent in 20 years.
How will we do it?
There may be some changes to the way we live and work in the future. Below is a guide to what the Productivity Commission expects will happen.
- More people will work for longer, until they are older. They will retire later (and some will not retire at all, but will continue to work well into old age).
- Many older people will work as volunteers. According to the Productivity Commission, the value of volunteering will rise from about 1.8 per cent to 2.2 per cent of GDP.
- People will have to pay for aged care services themselves. There will be an even greater emphasis on saving for one’s own retirement through superannuation and other investment plans, rather than relying on the old age pension.
- There may be more tightening of the means test for the age pension, and the pension age will increase further.
- There will be attempts at getting more productivity into delivery of services, that is, ways to deliver the same services for less cost by increasing efficiency.
Since health will take up such a big slice of the pie, there will have to be big productivity gains in health.
Some are already happening. For example, the increase in day-only surgery made possible by laparoscopic surgery avoids the need for a long hospital stay. Other big changes will be:
- Using outpatient services, rather than staying in hospital as an inpatient.
- More emphasis on preventive health measures, given that prevention is better than cure.
- Early intervention (the earlier someone gets treatments and the less advanced the illness, the easier it is to treat).
Nevertheless, there are likely to be rationalisations (i.e. cutbacks) in some services—perhaps not as many drugs will be listed in the Pharmaceutical Benefits Scheme, and less elective surgery done in public hospitals. And there is more pressure on people to take out private health insurance.
What can we do?
It is worth noting that not everybody agrees with this scenario. Critics of the Productivity Commission report argue that just because citizens are getting older does not necessarily mean they are less healthy. People can become healthier in older age (give up smoking, increase physical activity, eat a balanced diet) and cost the government less.
Some people may have more personal savings in the future that can be used to meet extra health needs. It may be that with fewer young people, there will be less money spent on schools and childcare, and more for health. Still, enjoying quality retirement requires us to stay as healthy as possible. According to the Australian Superannuation Funds Association citizens need to put away 12 to 15 per cent of an average wage over a 30-year period to finance a comfortable retirement.
But the good news is, according to the Productivity Commission report, that with inflation the cost of living standards and incomes will also rise. In 40 years Australians—young and old—may be twice as well off as they are today. In other words, we are likely to have a better retirement than our grandparents.
Part 2 in this series will discuss youthfully ageing (i.e. slowing the decline).
Australian Bureau of Statistics, http://www.abs.gov.au/AUSSTATS
Cavanaugh John C in: Volz J. (2000). Successful aging: The second 50. Monitor on Psychology, 31 (1).
Gould Elisabeth, Reeves Alison J, Graziano Michael SA and Gross Charles G, 1999.
How does experience influence the brain? Science , Vol 286:1 (15 October), 548-552.
Staying Young, Health Features ABC Radio, http://www.abc.net.au/health/features/ageing/staying_young.htm
News: Office of Communications, Princeton University 1999. Scientists discover addition of new brain cells in highest brain area: Finding reverses long-held beliefs and has implications for designing therapies.
Productivity Commission 2005. Economic Implications of an Ageing Australia, Productivity Commission Staff Working Paper. April 2005, Social Science Research Network, SSRN: http://ssrn.com/abstract=738063.
Project Manager and Editor, Quality4life
24 January 2007