Transcript: In Praise of Ageing
AIFS seminar: In Praise of Ageing - Thursday 12 June 2014
Audio transcript (edited)
The following audio presentation is brought to you by the Australian Institute of Family Studies (AIFS) as part of our monthly seminar series in which we showcase national and international research related to the family. The seminars are designed to promote a forum for discussion and debate. They are open to the public and free of charge.
Seminar facilitated & speaker introduced by Professor Alan Hayes AM
Dr Patricia Edgar AM
And thank you Alan for your introduction and your invitation to speak here this morning. This book has been surprising in many ways in the impact and I'm not saying none less so than being invited to speak at the Institute, something I didn't expect, and so here I am to speak to the experts. But I did not begin this book as a research project as such, I became interested in the process of ageing because I was ageing myself and I started to think about what is it that makes some people age very, very well despite wear and tear, despite the ups and downs of life, the traumas, the loss, the economic issues, the range of issues, some people do amazingly well and some people pack it in and go into a corner and close down their lives.
My inspiration was a woman, a friend I'd known for along time called Lesley Falloon and it was her 90th birthday and I was at a function at University College where we were both past students and I was due to have a hip operation from arthritis and I had to sit down. And I sat down and I watched Lesley in the centre of the room brightly animatedly just holding the floor, talking to everybody and I thought now what's going on there. And I was also pretty impressed by a friend of mine, Jim Brierley who at 89 was still skydiving and he was the oldest active skydiver in the world. So I began to think about putting together a series of case studies about exceptional people but they were people I knew, I didn't go out of my way to find a group. They weren't by any means a random selection, I did know them or I was introduced to them in the process.
And I interviewed them and got them to write down their stories and at the same time I looked into the research that existed on ageing that seemed to be influencing government policy and certainly found it sadly wanting. Now there were several Institute papers that I found that were very helpful that challenged the stereotype of ageing. But on the whole the underlying assumptions were that old age is a time of frailty, dependence, a burden on families and society, and something to be worried about that was really going to erode the fabric of the way in which we worked. Such assumptions need to be challenged again and to do that we need more and better research on ageing as a modern day social phenomena for ageing is certainly not what it used to be. And so I've decided to talk about the need for research and the sort of areas that I think would benefit from research.
Now for a start definitions of ageing are all over the place. The old age pension was first introduced over a hundred years ago at 65 for men and 60 for women. But since then our life expectancy has increased by 35 years and will continue to increase. The aged represent the fastest growing demographic and this stage of life is becoming the longest part of our life span. At 50 you are entering the second half of your life, you are not on the scrapheap. Now I don't know that anybody here would remember Don when he first came to the Institute but one of the most foolish things my husband ever did was to chase a prowler out of the house at about three o'clock in the morning and leap over a fence and smash his foot to smithereens. He was taken by ambulance to the hospital and he heard a nurse say as he was lying there stretched out, "We've got an old one out there." Now Don was 44 at that point so medically we are old early.
So the big question is when is someone old? South Australia's Ageing Plan has been based on interviews with Australians over 50, so is 50 the magic number. Is 70 the new 60 now that we're being expected to work to age 70. Are we old when we qualify for a seniors card, when we retire from the workforce, when we qualify for the pension, when we get grey hair, when we get sick, when we access our super, when we have grandchildren. Now the answers have very different policy implications but so far we do not have a clear handle on the meaning of this stage of life. And we cannot develop sensible policies and programs for people if we do not know precisely who we are talking about.
Do we become dependent when we become old? Treasury certainly seems to think so. They are obsessed with the GDP, which they measure four times a year and Treasury predicts the ratio of workers to retirees by 2056 will be 2.6 to 1. So they question how can tomorrow's workers be expected to finance so many retirees. But how useful is the measure of GDP in understanding this assertion. GDP ignores the productivity and value to society of older people through caring, through voluntary work and creative work. It is culturally linked to western ideas of independence, personal responsibility, individual agency and economic productivity. It ignores many other things.
For example Italy will estimate revenues from drug trafficking and the sex trade, contraband tobacco and alcohol as part of their calculation of gross domestic product from this year. The Bank of Italy in 2012 estimated the value of the criminal economy at 10.9 per cent of GDP. Now theoretically that would mean Italy's GDP result would come in higher than the government's 1.3 growth estimate. The grey economy of businesses that do not pay taxes is already calculated in Italy's GDP and was estimated to be worth between 16.3 and 17 per cent of the economy in 2008. Moreover the dependency ratio is based on current workforce participation and productivity figures. An increase in productivity through advanced technology or improved management systems of a mere .5 per cent would cover the cost of aged care and aged health expansion.
In a report recently prepared for the Monash Centre for Population and Urban Research titled, "The ageing of the Australian population: triumph or disaster", Katharine Betts concludes that over the last 35 years the so called dependency ratio had actually fallen. Older Australians have increased their contribution to the labour force and financial dependency on the wage earning population has fallen and her research certainly seems more accurate than what is being put forward by Treasury. The fact is that more older people are staying in the paid work labour force and they are still being economically productive. ABS stats on workforce participation show only 13 per cent of workers plan to retire by 60. Those who say they will never retire have gone from 384,000 to 575,000.
Now able-bodied people don't want to sit around for what is shaping up as possibly the longest stage of their lives without contributing. People want to work. Deloittes show the 5 per cent increase in paid workforce participation by people over 55 would add 48 billion per year to national income. Yet discrimination is keeping them out of the workforce and out of jobs. So we need to have major research undertaken to help anchor this discussion in evidence about job flexibility, work/family balance, age discrimination by employers and HR managers against which to measure progress rather than have repeated claims that the aged baby boomers are the pampered generation. In fact baby boomers do not form a unique bulge in the population pyramid. The cohorts following the baby boomers are larger. So even existing age specific rates of labour force participation will mean growing numbers in the paid workforce.
Now what even is productivity when the GDP fails to measure the significant dollar value of caring work, voluntary work, community work and creative work without which our economy could not function and none of which is a monopoly of the young. When Joe Hockey says people should work as long as they can, he discounts this contribution. Treasury should do some sums on the social capital that volunteer work produces and how that impacts on the economy. Now the Institute did some very valuable work back in 98 when Christine Millward published, "Understanding links between family experience, obligations and expectations in later life" and also, "Family relations and intergenerational exchange in later life" questioning the nature of dependency and showing the flows of both financial assistance and moral support run from old to young more than from young to old.
David de Vaus, Matthew Gray and David Stanton measured the value of unpaid household caring and voluntary work of older Australians. Now they found back in 2003 that those over 55 contributed the staggering sum of 74.5 billion a year to caring for spouses, grandchildren, and in other unpaid voluntary work. The figure would be much, much higher today. Women aged 65 to 74 contributed 16 billion in unpaid work inside the home, men of that age smaller in number contributed another 10.3 billion. And the press reported last year that nearly a million children received childcare on a regular basis from a grandparent, it's a huge contribution to the economy. So this question and about the meaning of dependency is a very important issue for government policy and how can commentators claim the dependency ratio will bring our economy to its knees when the value of volunteering is worth more to Australia than the mining industry, agriculture and the retail industry combined.
Dr Lisel O'Dwyer, Senior Research Associate at the Adelaide University School of Social Sciences has estimated the true value of Australia's 6.4 million volunteers as more than 200 billion a year as a conservative figure. Her study suggested that even a 1 per cent increase in the social capital, including volunteering, was likely to lead to falls in the homicide, sexual assaults, burglaries and vehicle thefts and it’s not just the direct economic contribution that helps. Volunteering and caring actually help people live longer and better lives. So in short, the assumptions about the burden of the aged, the dependency ratio and the future workforce are ridden with inaccuracy. How to counter negative stereotyping would be a very profitable research project to pursue.
Now what about health, because this is the area that they say is going to bring the system crashing down. Is this where the aged will be a burden? Not so if you look at the research in more detail and not if the medical profession would only move away from medication and technological intervention towards a more preventative approach. Health care costs are rising, but demographic ageing is not the sole cause or even the main cause. Improvements in care are the main cause for the increase and where demography does enter the equation, population growth has more than twice the impact of ageing. In 2009 Michael Corey used data from the year 2000 from 26 OECD countries and showed there was no connection between expenditure on health as a percentage of GDP and the proportion of population aged 65 and over. Better health means serious illness and morbidity are compressed into the last year or two of life.
Now there are many significant ways in which current health costs can be reduced and I talk about them in the book and won't list them here. But medical guidelines for the dying need to be improved. We're not very good at talking about death. "I'm not afraid of dying" Woody Allen said, "but I don't want to be around when it happens". And in the absence of talk, millions of dollars are wasted on futile aggressive interventions for patients unable to speak for themselves and whose death is inevitable. It's been calculated that advanced care planning would save 250 million annually. The APA, the psychiatric association's diagnostic manual lists 374 disorders for depression with criteria so vague that they would cover everybody here. Australia has a population of 23 million and recently Patrick McGorry claimed that four million of us, 17 per cent, have a mental disorder. Now dare I say I do not believe him and this is where more research on what these things mean and how they should be treated is needed. And this is where research on family relationships and the intergenerational contact might be useful. One factor that stands out in the research on healthy ageing is the issue of social isolation. More than pain or any chronic medical ailment, lack of social contacts and support can be our undoing.
The Institute's Family Matters back in 1991 Issue 30, highlighted this topic with an article by Eileen Walcott on the, "Influence of family relationships on later life" and she concluded that the majority of men and women aged 50 to 70 years, for them family contact across the generations was important and frequent despite the fact that young families often lived a distance away from their ageing parents. Now a repeat survey of Eileen's study 25 years on should reveal interesting issues for family relationships and support between generations given the changed patterns of marriage, separation, divorce and remarriage experienced by people on the verge of entering later life. Where is the research on support for the aged when divorce has disrupted contact between grandparents and grandchildren, or where a new partner does not get on with their in-laws or where perhaps the existence of multiple parents and grandparents transforms the nuclear couple family into an extended lattice family with multiple support networks.
We need research on how the trend for young people to live at home into their 30s, delay marriage, bring sexual partners into the parental home, plus the rising cost of housing and extended earn or learn policies for unemployed youths might all combine to alter the patterns of intergenerational relationships. And in particular the way family support systems cope with an ageing population. Such patterns will generate new challenges for future public policy decisions and perhaps we're moving gradually to a more interdependent concept of family life because so called independence, autonomy and privacy are less possible in a threatened economy with environmental decline. They're all questions for examination.
I've recently become an ambassador for NARI, that's the National Ageing Research Institute, and I've been doing research on chronic obstructive pulmonary disease, which affects one in five people in Australia and the use of the telephone in relation to depression. And not surprisingly they are finding that telephone contact support has the potential to assist people with chronic disease who are suffering anxiety and depression. Now in this technological age we should be developing social networking sites that link the old and the young. I was taken with research I read about in Holland by an inventive group of medical professionals at an institute in Amsterdam called the Waag Society.
They used the Internet to pair elderly shut in a nursing home with young partners. Some of the young people volunteered and others who were jobless were paid to be involved. The senior citizens some of whom were seen as virtually senile had to learn to use the computer and expectations were quite low but the elders jumped at the chance to be learning something useful, to be doing something that actually connected them to young people. And they felt happier. There were no scientific tests, there were simple self reports from the people who said they were feeling better. Not just from the elders but from the kids too, both groups began to feel a sense of optimism and soon the nurses noted that seniors weren't requesting as much medication for their pain, anxiety, depression, memory loss or even their physical ailments. And cognitively they were doing things that a few months earlier had seemed beyond their mental grasp. They weren't dying as fast as they used to and so more beds were required.
Now it makes very good sense to support such activities. In Australia 66 per cent of those over 75 say the Internet helps them connect with their families and makes them feel more secure in their homes. The baby boomers are the fastest growing users of information technology and appropriate training in a supportive environment is very effective in assisting older workers to learn new technology systems effectively. Cost's an issue so Australia's Telco could show some community leadership and subsidise rates for seniors to get online. And what about a social network that links the old and the young. I Googled "old and young" to see if anybody around the world was doing such a thing. Do you know what I found? Porn sites. Every time you link young, old, old, young, that's what you get. So you need a new name but it's a good idea and potentially a commercial idea.
Where is the research on ageing and how ageing affects different ethnic and religious groups, on migrants and refugees with extended families. I read in the paper just this week that a number of seniors from Italy and Greece are going back home to live because they can't afford to live in Australia on their pensions. We need to look at the way older migrant groups experience language difficulties when confronting a medical and aged care system based on English and on cultural assumptions that they do not share. And what of gender. As far back as Simone der Beauvoir's lament about her unattractive ageing body, she was 50, but her partner, her womanising partner Jean Paul Sartre was not helping. And there's been a clear gender difference in ageing because of women were traditionally more dependent. But was that ever true with women who were peasant farmers or factory workers or servants who worked until they died.
And now that women are better educated, more likely to stay in the labour force and more aware of their human rights, how has this affected the way they age. Better education is clearly related to better health, higher incomes and life expectancy. Yet we know little about how that is linked to their experience of marriage, having children and the fact that smaller family size increases the burden of caring for an ageing parent on the surviving children, usually the female children. Now in my book there are case studies of women who have reinvented themselves and survived well after divorce or the death of their partners. We know that male life expectancy is lower than that for women but today's workplace is probably changing that. Still men delay seeking medical treatment more than women. But women are now subject to many of the same stresses and diseases that have affected men. Divorce and job discrimination may still impoverish women more than men but how does this affect ageing, when women maintain family and friendship relationships more effectively then men.
According to the 2007 National Survey of Mental Health and Wellbeing, 30 per cent of women with a mental health problem visited a GP compared with 18 per cent of men. Pauline Mackel has found that Australian men aged 80 and above have the highest suicide rate of any group. The older men have lost both meaningful workplace activity and their ongoing partnership resulting in a loss of identity. Now these are all areas for further research. As well little is known about sexuality because there are fewer men than women, odder men are more likely to have a sexual partner and to be sexually active. But overseas research has found that older adult participation in satisfaction with sexual activity has increased over time and a recent PhD at Swinburne by Sue Malta has found that older women aged 60 plus were just as likely to initiate new relationships on Internet dating websites as the men. She discovered that relationships became sexual quickly and for many women they were more enjoyable than their previous mostly long term married experiences. Aged care homes are rife with newfound love affairs. The stereotypes are again wrong, with older adult needs and priorities regularly left out of vital national health research and policy agendas.
Now I want to say a few words about the notion of successful ageing. I've been accused of promoting an unrealistic image of the all singing, all dancing, all jumping happy, smiling oldie leaping into the grave which is just as unproductive a stereotype of all old people as frail, dependent and demented. Some recent British research directly challenges the concept of successful ageing, suggesting that although we want to stay healthy and active as long as possible, the idea has run away with itself and is now almost a new form of ageism. To age successfully almost means not to age at all and is based on the notion that everyone starts from a place of health and high functioning. They ask what successful ageing might mean to people who've had a long-term physical or intellectual disability or a chronic mental illness or come from a culture that's less individualistic and preoccupied with the importance of independence.
How they ask can we involve more marginalised groups, people who have compromised health in our thinking about ageing and in many area is rife for research here. I wrote my book in order to challenge current negative policies and indicate how increasing longevity can be positive for society as a whole as well as for the individual experience of ageing despite the inevitable onset of physical deterioration and death. It has to be noted that while about 30 per cent of one's likelihood of living to 100 is determined by genes and longevity does run in families, several longitudinal studies have shown personality and attitude are important in determining whether we will live a long life well. The Harvard Grant study which is overseen by George Vaillant and he's coming to Australia in November, begun in 1938 has found that controlling for variables such as income, ill health and divorce, those with a positive attitude to life, those who saw ageing as an opportunity to reinvent themselves and get on with the business of living, actually did live much longer. Demography and genes do not fully determine destiny, lives can change and get better.
Now I was going to talk about Alzheimer's but I don't imagine too many of you here are worried about that at the moment but it's - I will cut it very short and say that while they've been looking for a pharmaceutical solution without much success, what they are finding is that the most important thing anyone can do is exercise the brain. And there's some really interesting research in America by Dr Yaakov Stern where he's performed autopsies on 137 people who were diagnosed with Alzheimer's in the 1990s. He compared the brain pathology on death with the symptoms that the patients exhibited during their lifetime and the team found that some severely disabled patients had brains that turned out to be far less diseased than expected and that patients with few Alzheimer's disease symptoms had brains that were badly ravaged. So what could account for the difference, and his belief is that complex brain operations were taken over by the un-diseased parts of the patient's brains, what he calls cognitive reserves.
So how do we get them and how can we minimise, slow down or even reverse cognitive decline. And the answer seems to lie in brain exercise. Not just doing the daily crossword but in continuing meaningful education, enjoyable work, pleasurable leisure activities, physical exercise, social interaction, learning new skills like a new language or computer skills, playing video games and interacting on social network, the brain needs to be active and stimulated with rich and new experience. There is a lot of nonsense that is talked about the dangers to youth of multitasking, there's no such thing as monotasking and we know that, our brain is doing all sorts of things all the time. The brain is inquisitive by design and what confounds the brain enlivens the brain nearly they're (indistinct). And to relegate the old to passive retirement or having a well deserved rest or sitting drugged in an aged care home condemns many to unnecessary decline.
So my argument is that we must accept the responsibility for looking after ourselves to the best or our ability physically and mentally and I don't think that just applies to old people, that applies at every stage of life. We must make an effort to reinvent work, our purpose and ourselves as circumstances change over a long life. But it's not just a matter of self responsibility, our attitude will make a difference but we have a right to respect and to be respected as individuals given access if we want it to work opportunities both paid and unpaid, and good medical support. The language used to talk about us, our cultural attitudes and media reporting should not be allowed to continue to create and amplify social problems for those living the second half of their lives that can be solved and bring benefit to us all. Portrayals of the aged as a burden just do not help.
So it's time to praise age and celebrate ageing, not bemoan what is a natural stage of our lives. Thank you very much.
END OF TRANSCRIPT
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