Alan Walker Professor of Social Policy and Social Gerontology University of Sheffield, UK and Carol...

Alan WalkerProfessor of Social Policy and Social Gerontology

University of Sheffield, UK

Carol WalkerProfessor of Social PolicyUniversity of Lincoln, UK

European Association of Service Providers for Persons with Disabilities (EASPD) Conference on Ageing and Disability,

Graz, 8-9 June, 2006

Ageing and Disability: A Quality of Life Perspective

• Ageing and Disability in Europe

• Gerontological Evidence on Quality of Life

• Policy Priorities for Quality of Life

ROAD MAP

Alan Walker, EASPD Conference on Ageing and Disability, Graz, 8-9 June 2006

Ageing and Disability in Europe

The Ageing of the European Population

• Ageing means more spending on health, social care and pensions

• A simple correlation between ageing and disability: ageing means more disability

The Negative Myths About Ageing Societies

• Current prevalence rates

• Projections

• The compression of morbidity

Ageing and Disability

16-24 25-34 35-44 45-45 55-64 65-74 75-84 85+

Age and Functional Limitation - EU 15 1998

Disability rates for EU 15 (1999)

Ageing and Disability

Proportion reporting a physical,

sensory or mental disability 23%

Of whom: reporting severe disability 8%

Proportion 75+ reporting a physical,

sensory or mental disability 45%

Of whom: reporting severe disability 27%

6062646668707274767880

1968 1971 1974 1977 1980 1983 1986 1989 1992 1995

Australia

France

Canada

Life expectancy

Severe disability-free life expectancy REVES 1998

Severe disability-free life expectancy, males at birth

Dependency Projections 2000-2050

Growth in Numbers of Older People with Dependency Germany Italy Spain UK

1. Constant dependency rates 121% 107% 102% 87%

2. 1 year rise in life expectancy delays dependency by 0.5 years

73% 41% 79% 61%

3. 1 year rise in life expectancy delays dependency by 1 year

34% -1% 56% 35%

• Absence of standardised data

• 2.3% of the population of the EU 15Range: 1.9% France, Sweden - 3.4% Spain

• Projections 1995-2020: 60+ 77% increase<15 62% increase

Ageing with an Intellectual Disability

Gerontological Evidence on Quality of Life

Professional vs. Lay Concepts

Household Composition

Education

Labour Force Participation

Household Income and Financial Resources

Living Standards and Ability to Participate

Health Status

Family Life

Community Life and Social Participation

Other Domains eg. housing tenure, life satisfaction

Fahey, Nolan and Whelan, 2002

Core Life Domains

http://www.shef.ac.uk/uni/projects/gop/

Evidence from the UK Growing Older Programme

having good social relationships with family, friends and neighbours;

having social roles and participating in social and voluntary activities, plus other activities/hobbies performed alone;

having good health and functional ability; living in a good home and neighbourhood; having a positive outlook and psychological well-being; having adequate income; maintaining independence and control over one's life.

Source: Bowling et al (2002)

Alan Walker, Current Research in Gerontology and Social Policy, Hong Kong Baptist Alan Walker, Current Research in Gerontology and Social Policy, Hong Kong Baptist University, 26 April 2006University, 26 April 2006

The Foundation of a Good QoL in Old Age

Maintaining health and independence, social activities

and relationships, Neighbourly and safe areas, Local amenities and services, Participation, Transport, Finance.

Source: Bowling et al (2002)

Maximising Quality of Life

The Magnificent Seven

• Employment

• Maintenance of Health and Autonomy

• Care and Carers

• Social Inclusion/Participation

Policy Priorities for Quality of Life

Employment Ratio Among Disabled and Non-Disabled People

Demographic Characteristics of Disabled and Non-disabled Working Age Population (%)

Disabled Non-disabled

Age (years)

16-24 6.4 17.0

25-34 12.6 25.5

35-44 17.7 23.6

45-54 24.9 19.0

55-64 38.4 14.9

Gender

Male 47.3 48.9

Female 52.7 51.1

Educational level

Low 52.7 42.7

Medium 34.5 39.2

High 12.8 18.1

Source: ECHP, 1996

• Cardiovascular Diseases (eg. coronary heart disease)

• Hypertension

• Stroke

• Diabetes

• Cancer

• Chronic Obstructive Pulmonary Disease

• Musculosketal Conditions (eg. arthritis, osteoporosis)

• Mental Health Disorders (eg. depression, dementia)

• Sensory Impairment

The Contexts of Care’ The Places of Care: History and Outlook from XV to XXI Century, Turin, June 18-20th, 2004

Source: WHO (1998)

Major Chronic Conditions Affecting Older People

Development of NCD

ES: socioeconomic status PA: Physical activity Source: Aboderin et al., 2002, p.17

Fetal life

SES;maternalnutritionalstatus;birthweight

Infancy andchildhood

SESdiseasesgrowth rate

Adolescence

Obesitylack of PAsmokng

Adult life

Established adult

Behavioural/biologicalrisk factors

Accumulate

(range)

Scope of non-communicable diseases prevention: a life course approach

Proportion of Disease Burden (DALY) Attributable to Risk Factors (all ages)

Smoking 9.0

Alcohol use 8.4

Vegetable/fruit deficiency in diet 3.5

Overweight 3.7

Fat content of food 1.1

Physical inactivity 4.4

Relative poverty 3.1

Work environment 3.6

Unfortunately and incorrectly people with potentially disabling conditions often are not recognised as a target population for primary prevention effort, despite the fact that having a potentially disabling condition frequently increases the need for good health promotion and disease prevention practices.

The Contexts of Care’ The Places of Care: History and Outlook from XV to XXI Century, Turin, June 18-20th, 2004

Pope and Tarlov, 1991, p.105.

Prevalence of Care Dependency in EU

Projected Increase in Numbers of Older People Receiving Formal and Informal Care 2000-2050

Germany Spain Italy UK

Numbers receiving informal care 119% 100% 109% 72%

Numbers receiving home-based care 119% 99% 119% 92%

Numbers receiving institutional care 127% 120% 81% 102%

Growth in expenditure 120% 115% 96% 102%

Expenditure as % GDP in 2050 2.72 1.39 1.94 2.75

Age Distribution of Carers in the EU 25, 2005 and 2030 (%)

2000 2030

Carers providing

+20 hrs pw

Carers providing

+35 hrs pw

Carers providing

+20 hrs pw

Carers providing

+35 hrs pw

25-49 38 38 29 29

50-64 38 38 39 39

65+ 24 24 31 32

Social Cultural Civic Services Nbrhood Financial Material

Excellent

Very good

Exclusion by self-assessed general physical health

Social Cultural Civic Services Nbrhood Financial Material

Not depressed

Depressed

Exclusion by depression status (CESD questionnaire)

• Combating age/disability barriers to employment

• Active ageing: promotion of health and well-being across the life course

• National strategies for ageing carers

• Promoting social inclusion: national and local policies

Key Policy Directions:

Responding to the Policy Challenges

• Combat ageist stereotypes (eg. age awareness training)• Base support on ability and potential not disability• Maintain aspirations and expectations regardless of age• Retain the goals of inclusion, participation and choice• Initiate health promotion: it is never too late• Treat disabled people and their family carers as equal partners in

planning their lives• Provide a single point of contact with advice on services and social

protection• Instill a service philosophy based on consistent principles such as

social inclusion, empowerment and normalisation

Key Messages for Service Providers:

• Ageing and Disability in Europe

• Gerontological Evidence on Quality of Life

• Policy Priorities for Quality of Life

ROAD MAP

• Conclusion

THE END

THANK YOU

Alan Walker Professor of Social Policy and Social Gerontology University of Sheffield, UK and Carol...

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