Second Opinion: Older relatives and future selves: our attitude needs to change

Once we start talking about older people in society, the discourse quickly assumes gloomy apocalyptic tones of burden

Most of us have the opportunity for a longer and richer relationship with parents, grandparents, aunts and uncles. Photograph: Thinkstock

Most of us have the opportunity for a longer and richer relationship with parents, grandparents, aunts and uncles. Photograph: Thinkstock

 

One of the more entertaining moments in the recent history of the Oireachtas was when Joe Higgins, the socialist TD, looked into his wardrobe and found that his socialist clothes had been taken by another. Recent events showed that political cross-dressing has not yet disappeared, even with the more relaxed sartorial standards of the 31st Dáil.

From an apparently abandoned and cobweb-infested PD wardrobe, Labour TD and junior minister with responsibility for older people Kathleen Lynch not only took out the costume of the so-called Fair Deal but also spruced it up for a kite-flying excursion on the need to further constrict its already tense fiscal belt.

That we as a society have got to a point where we have not only acquiesced in putting a financial cap on the very genuine healthcare needs unique to one group, but tolerate consideration of further increasing their already significant financial burden, is one of the great puzzles of gerontology.

Given that it follows the scandal surrounding nursing-home payments, whereby the State deliberately concealed entitlement to nursing-home care to huge numbers of older people, it seems that there is a bizarre disconnect between what we individually feel for our older relatives and our collective attitude to older people as a group.

On the one hand, compared with previous generations and thanks to our increasing longevity and improving health status, most of us have the opportunity for a longer and richer relationship with parents, grandparents, aunts and uncles. This longevity dividend evokes feelings of warmth and protectiveness within our families.

Tones of burden

However, once we start talking about older people in society, the glow dissipates and the discourse quickly assumes gloomy apocalyptic tones of burden.

Little matter that we have gained so much from ageing, as the stupendous cast of the current production of A Midsummer Night’s Dream in the Abbey – many in their 60s, 70s and 80s typify – or that rates of disabling illnesses of later life, such as stroke and dementia, are falling. We have also succumbed to an associated health-economics apartheid, whereby the needs of those with cancer and cardiac disease should be accommodated without charge as an absolutely reasonable goal of the health system, but equally grave needs arising from age-related diseases such as Alzheimer’s and stroke can be characterised as an unreasonable burden.

Headlines “blaming” healthcare pressures on increasing numbers of older people remain all too common. This is wrong at so many levels: given that we have a 15 per cent drop in health funding since 2008 and an 11 per cent drop in staffing, against an increase in overall population and admissions, the fundamental reasons for the pressure lie elsewhere, in another parliamentary wardrobe.

We need an updated version of Swift’s satire, A Modest Proposal, in which he suggested that the impoverished Irish might ease their economic troubles by selling their children as food for rich gentlemen and ladies. The full title of the piece – for Preventing the Children of Poor People From Being a Burthen to Their Parents or Country, and for Making Them Beneficial to the Publick – catches neatly the sense that a different demographic group were once regarded as a burden.

Through biting wit we are repelled by the idea that children could be caricatured as a burden: what similar spark might put our collective humanity back on course for our older relatives and our future selves?

A radical rethink

A modest proposal would be a radical rethink of how we characterise care for the inevitable frailties of later life and, in particular, exercising extreme caution with the word “burden”. There are burdensome aspects to caring for children, engaging in relationships, and the everyday business of life, but we do not allow these to be defined predominantly as burdens.

Yet all too often caring for our older loved ones is expressed as “carer burden”. Given that most of us want to care, a much better phrase is “burdensome aspects of care”.

This formulation retains the warmth of our caring urge while teasing out the aspects of care where we could benefit from expertise and support from health and social-care services.

Repositioning support and care for us as we age as both desirable and manageable must become a priority for Irish society and its politicians, requiring fresh thought and a much closer union between our family and societal views of older people.

Prof Des O’Neill is a consultant physician in geriatric and stroke medicine and professor of medical gerontology at Tallaght Hospital and Trinity College Dublin. See iti.ms/166DZXu; Twitter: @Age_Matters

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