Toxic expressions of bias against elderly

Official attitudes towards the elderly, as evidenced in the Budget and Bills before the Dáil, are mired in prejudice, write Prof…

Official attitudes towards the elderly, as evidenced in the Budget and Bills before the Dáil, are mired in prejudice, write Prof Desmond O'Neilland Dr Cillian Twomey

Illness is the night-side of life, a more onerous citizenship . . . everyone holds dual citizenship . . . it is impossible to take up residence unprejudiced by the lurid metaphors with which it has been landscaped. - Illness as Metaphor, Susan Sontag

The stigma and poor services associated with cancer in the 1980s prompted Susan Sontag to write her insightful and influential pamphlet, Illness as Metaphor.

Affected by her own experiences in the then under-developed services for breast cancer, she explored how negative societal perceptions and expectations hugely affected the type of services available to patients with cancer and tuberculosis.

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Since then, and partially in response to the awakening of public opinion prompted by her work, there has been a sea-change in the nature, funding and reduced stigma of cancer treatment and prevention services. If alive today, Sontag would surely find a rich vein for analysis in attitudes to the two most common age-related illnesses, both neurological, dementia and stroke.

The stigma of dementia has been described to devastating effect in a recent publication by the Alzheimer Society of Ireland. Despite some advances, assessment and treatment services for both illnesses are under-developed to a degree unimaginable in comparison to the strides that the Irish nation has made in services for cancer and cardiac illness.

In the case of dementia, the provision of memory clinics is almost non-existent, and only two public hospitals in the State provide neuropsychology assessment, which is vital in early and accurate assessment of Alzheimer's disease and the other dementias. Care in the community can be difficult to receive and is often poorly co-ordinated.

The Government Action Plan for Dementia is still largely unfulfilled. Stroke care also suffers. Although it is recognised that treatment in a stroke unit can reduce the chances of death and disability by 25 per cent, only a tiny minority of those with acute strokes have access to such a service. Rehabilitation, both in the hospital and the community, lags well behind recognised norms.

However, it is in the proposed changes to funding support for nursing-home care in the Budget and the Health (Nursing Homes) (Amendment) Bill 2006 under review in the Oireachtas, that the negative attitudes to stroke and dementia find their most toxic expression: ageism meets neurologism, so to speak.

Almost no older person wants to enter a nursing home, a finding borne out by repeated surveys of older people. When they finally change from their own home to a nursing home it is nearly always due to dementia, stroke or a combination of both illnesses. A recent study of census data has confirmed the presence of high levels of disabilities, often multiple disabilities, among residents of Irish nursing homes.

The Irish Gerontological Society is aware of major concerns about the inadequacy of care standards to meet the complex needs of this very vulnerable group, the mechanisms for monitoring existing standards, as well as the provision of appropriate expertise, therapy and specialist support in nursing homes.

No older person objects to a proportion of their pension being used for the board and lodging aspect of this usually reluctant change to a new home where their health and social care needs (which cannot be easily disentangled) should be met.

However, it now seems that older people, who can avail of a publicly funded bed now, will be asked to provide funding for this care over and above their lifetime of taxation and pension contribution. The contrast with cardiac and cancer treatment could not be more stark: in the case of certain cardiac and cancer treatments, tens and even hundreds of thousands of euro will be spent without anyone imagining that the patient should hand over a percentage of their house to the State.

The debate on funding is also be marked by inappropriate alarmism, a form of false demographic catastrophism. In fact, older people are fitter and healthier: disability is dropping among older Americans at a rate of 1.5 per cent a year.

In tandem, nursing home use is not increasing with increasing numbers of older people (albeit that there are regional deficits). The number of publicly funded nursing home beds in the Republic has remained constant at about 15,000 between 2000 and 2004.

Even alarmist forecasts of funding implications of nursing-home care have been met head on by the Royal Commission on Long Term Care in Britain, which showed that the nursing-home costs of a growing (and healthier) older population can be quite readily met within the parameters of all reasonable forecasts of economic growth.

Although a minority of older people live in nursing homes at any one time, this fact conceals the reality that a higher proportion of us will spend some time in a nursing home, usually as a result of stroke and/or dementia. We are all future older people and have a direct stake in ensuring that access to care, its standards and its costs are no different for stroke and dementia than they are for cancer and cardiac disease.

Desmond O'Neill is secretary, and Cillian Twomey president, of the Irish Gerontological Society