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Ageism must be tackled with more focus on non-communicable diseases

Less money spent on older people than young for similar conditions

Adrian O'Dowd

Wednesday, 04 April 2012

Clinicians should tackle unfair ageism in health services and make ageing a global priority, according to correspondence published today in The Lancet.

Doctors writing in the journal said that old attitudes to ageing should be transformed and more attention given to dealing with non-communicable diseases (NCDs) in older people, which represent the largest burden of disease in this age group.

In the same week as the World Health Organization’s World Health Day is due to focus on healthy ageing, The Lancet letter by Dr Peter Lloyd-Sherlock, School of International Development, University of East Anglia, and colleagues stresses the need for change in attitudes towards older patients.

The authors said: “Depictions of older people remain stereotyped and generalised, distorting public opinion and skewing policy debates.”

They cite the example of economic dependency ratios – one of the commonest measures of ageing – being used, which assume that anyone aged 65 years or older is unproductive.

“Similarly, the use of disability-adjusted life years to capture the health of a population explicitly views older people as a social and economic burden,” they said. “Yet many older people continue to make substantial social, economic, and cultural contributions, which can be enhanced by measures that improve their health and functional status.”

Even worse, they point out that health spending and health-service use are more closely associated with how close a person is to death than with chronological age.

“Indeed, it is often the case that less is spent on older people than on younger people with similar conditions,” they said.

Although there were variations in the functional status of older people both between and within countries, the authors said substantial improvements in status could be achieved with relatively cheap and simple interventions such as the effective management of hypertension, diabetes, and high cholesterol, and the promotion of healthy lifestyles, in particular regular physical activity.

“Yet in most countries these interventions are not available to large sections of adult populations,” says the letter. “The failure of national governments and international agencies to prioritise these cheap and effective treatments represents a missed opportunity to reduce mortality, illness, and disability on an unprecedented scale.”

They conclude: “If we do not challenge existing policy paradigms and the social attitudes that underpin them, population ageing might indeed lead to a crisis in the provision of health and welfare services. Instead, we should see it as a welcome opportunity to challenge outdated public perceptions, political priorities, and policy models.”

An accompanying editorial in the journal says that five years from now, for the first time in history, the number of people aged 65 years and older will outnumber children younger than 5 years.

The editorial says: “Advances in medicine, socioeconomic development, and declining fertility have all contributed to this demographic shift, and countries need to adapt to this change in a positive and inclusive way.

“Sadly… population ageing is often framed in negative terms. Older people are viewed as a burden to society and resources. Older people contribute to society in many ways. They also face specific health problems related to the ageing process that have been neglected internationally and deserve attention.”

How would qualify the communication between primary and secondary care services? (See OnMedica News 20/04)

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