Ireland is getting older, faster. The feat of an ageing population is considered a societal success – a measure of how health services successfully battle disease and of ever-improving social conditions. But it brings its own problems.
Even as the shortage of hospital beds has caused widespread angst and pain for patients and their families in the last week, concern is growing among healthcare professions that urgent action is needed to head off something potentially worse in the near future.
The number of people in Ireland aged 65 and over has increased by 32.8 per cent since 2007, a faster rate of growth than other EU countries. It is expected to have significant implications on healthcare demand and expenditure.
The Central Statistics Office (CSO) estimates that by the year 2046, Ireland will be home to just over 5.6 million people.
Padraig McGarry, chairman of the GP committee of the Irish Medical Organisation, has warned that at least 325 new hospital beds will be needed every year for the next two decades to keep pace.
In terms of those just above the pension age (65- 69), the number is expected to rise from 205,700 in 2016 to 354,600 over 30 years. For those 85 and over, the figure jumps from almost 70,000 to 263,000.
Dr McGarry said there will be about 20,000 more people over the age of 65 every year until 2040. At the same time, he added, “there is growing and growing waiting lists for people, ostensibly for conditions that should be treated in general practice if the resources were there to do it”.
In its Key Trends 2016 report, the Department of Health said life expectancy has increased by almost 2½ years in a little over a decade, and has been consistently higher than the EU average. A century ago it was about 50; today it is almost 77 for men and 82 for women.
Much of this is due to significant reductions in major causes of death, such as circulatory system diseases and cancer. Survival rates for breast and colorectal cancer have also improved in the past 15 years. Mortality rates from respiratory diseases (including cancers) have declined by almost 3.6 per cent since 2010.
But while an ageing population is celebrated, it presents healthcare challenges.
In 2016, 52.9 per cent of men and 53.5 per cent of women aged 65 and over reported chronic illness or other problems, according to the Department of Health.
Diseases of the circulatory system accounted for 33.4 per cent of 2015 deaths for over-65s. Deaths from respiratory diseases accounted for 20.2 per cent.
The proportion of people aged 85 and over in long-term care settings increased between 2013-2015, accounting for just over half of all patients.
Total public health expenditure has risen from €13.7 billion in 2007 to an estimated €15 billion in 2016. Estimates for 2016 indicate a 4.8 per cent increase in spending from 2015, but health expenditure is not broken down by age.
Dr McGarry said a properly resourced general practice sector is crucial to help deal with the growing population. However, today 30 per cent of GPs are over 60 and there are concerns about how they will be replaced.
“So all the things that we would like to do in general practice and that we are trained to do, and that is much more economically viable . . . if you can’t retain your workforce, you are going to run into a serious deficit between what you should be doing and what you will be able to do,” he said.
Sicker with age
The CSO's Irish Health Survey 2015 sets out the expected rise in illness with age: 18 per cent of the 15-24 year olds reported a long-standing condition compared with 59 per cent of those 75 years and older.
It found that 68 per cent of the 15-24 group had visited a GP in the previous 12 months. This rose to 92 per cent at 75 and over. In addition, 87 per cent of this older category used prescription medication.
In 2013, the government produced the National Positive Ageing Strategy, which looks at grasping “one of the most significant demographic and social developments that Irish society has encountered”.
Its aims include the prevention and reduction of chronic disease and the provision of “affordable, accessible, high quality and age friendly health and social services”.
“Increases in population will be matched by increases in the prevalence of diseases such as dementia, arthritis, diabetes, sensory impairments and congestive heart conditions,” it noted.
Government policy looks to support older people living in their own homes and communities with the aid of “critical” home care packages. However, there are never enough of them – and demand will only increase.