Speech to Age Concern

Good morning.

Thank you for the opportunity to speak with you today about the topic you've given for me: "How can we move beyond the perception that older people are a burden on the health system?"

In this speech I will describe the challenge of health policy not being the over 65s but the over 80s, and then touch on the significant challenge that dementia, will present the public health service.

I would like to acknowledge Liz Baxendine, National President of Age Concern NZ, Chief Executive Anne Martin and Managers and all delegates who have travelled here to attend this conference.

Oldest Federal Judge

In the New Zealand Herald this week was a report about the United States' oldest federal judge who is still delivering justice at the age of 103.

Judge Wesley Brown has presided over his Wichita court room for nearly fifty years.

He arrives at court in a van that collects him from his assisted living home and

steers his electric chair into the courtroom.

Next to him, behind the bench, among the court documents is his oxygen tank.

At 103, Judge Brown is the oldest federal judge in America by only six years. There are another eight in their nineties and more in their eighties.

Judge Brown values his job because he says it gives him a reason to live.

As long as you perform a public service he says you have a reason to live.

Living proof that older - even very much older - people, do make a valuable and active contribution.

Population changes

There's no getting away from the reality our population is ageing.

In New Zealand in 1950 children under the age of five made up ten per cent of The population, and people over eighty were just one per cent.

Since then the number of 80 year olds has quadrupled to 153,000 in 2010.

And that number will double again by 2030 to 300,000.

In just twenty years' time, it is predicted the two generational groups will be neck and neck - one adult over eighty for every child under five.  The so-called population pyramid is becoming a rectangular block.

The old are not so old anymore

The conventional wisdom is the older we get the more likely we are to suffer aged related illness or disability. And that coupled with more of us ageing will crash public health systems around the globe.

But there is increasing evidence that the so-called burden of an ageing population may not be as dramatic as people fear.

A report published in Science magazine late last year argues that rising life expectancy and improved health means while there will be increasing numbers of older people, physically, they will age more slowly.

The American and Austrian authors say that the current methods of predicting the impact of an ageing population are wrong because they are based on chronological age... and consider people as being "old" when they are 65.

The authors say people are living longer healthier lives and, basically, "the old are not so old anymore".

People are fitter, healthier and more active, longer.

As a cyclist I can vouch for the speed of some of the more senior members of the cycling fraternity!

And how many 65 or seventy year olds do we meet these days who we'd describe as dependent?

In 2006, one in six New Zealanders aged 65 and over was in paid employment.

That's a big jump up from less than one in ten over 65 year olds working in 1986.

The Science report is saying people can look forward to fewer years of ill-health, much later in life and possibly for a shorter period.

They argue the expected tidal wave of older people dependent on expensive health and welfare services may actually be more of a ripple - for some time to come.

The two effects of getting older and healthier for longer offset one another.

This suggests that there may not be unmanageable pressure due to ageing or end of life expenditure in the medium term.

But we must still plan for the future to meet the increasing needs of older New Zealanders.

Over eighties

Much of the official analysis of ageing defines older people in terms of those over age 65. Clearly this doesn't reflect the realities of ageing today. In fact, more and more commentators suggest the age band of focus should be considered at 80+.

One in four people over 65 are aged over 80.

Yet, if you look at the budget spent on those over 65, half the money spent on health services for that population is spent on over 80 year olds.

Over 80 year olds use 76% of aged residential care, 70% of home based support hours for over 65s, 63% of respite related care and 32% of all elective surgery carried out on older New Zealanders.

50% of over 80 year olds are living independently - and two out of three of them are women.

So while there is no need to panic about an imminent tidal wave of older New Zealanders, we do need to prepare for shifting resources to support the needs of our growing group of much older New Zealanders…sometimes referred to as "the frail elderly".

The messages are clear: we have a window of opportunity to plan and to get ready, as demand remains relatively stable over the next few years

Dementia

With more of us living over the age of 85, many more people are now living with dementia.

Dementia is a severe and devastating disorder for both sufferers and their families - and it is increasingly making itself felt amongst us.

Ensuring the health service supports people with dementia will be very important into the future.

The number of people with dementia (of any age) is expected to increase considerably. Estimates show that the numbers of New Zealanders who are living with dementia is approximately 41,000; this is expected to increase to 77,000 by 2026.

The rates of growth may be affected by various risk factors associated with dementia.

· A study  of more than 10,000 people showed that obesity was associated with a 74 per cent increased risk of dementia 25-30 years later, while overweight people had a 35 per cent greater risk.

· Previous work has linked high blood pressure and high cholesterol with increased risk of Alzheimer's disease.

Protective factors may include physical activity:

· A study at Johns Hopkins in the US found that people who engaged in four or more physical activities, from gardening to biking, had about half the risk of dementia compared with those who engaged in one or none.

· Time spent in full-time education also appears to be negatively associated with dementia.

· Some research has suggested a possible link between a reduced risk of Alzheimer's disease and people with mentally demanding jobs

But as you know, there is no cure and the best science can do is slow down progression. An Australian study suggests that if the onset of dementia can be delayed 5 years, then by 2050 there would be 50% fewer people with dementia than otherwise projected.

PHARMAC's decision last year to fund its first first-ever dementia drug enables thousands of people diagnosed with Alzheimers or related types of dementia to have a better quality of life for longer.

We also need to concentrate on making sure people suffering from dementia receive quality services and live as good a life possible- whether they live at home or in residential care.

Earlier diagnosis and earlier provision of support will mean people will be able to stay longer in their homes in comfort and safety.

One important way to achieve that is to better support those who care for their older people with dementia at home.

We need to be mindful of funding limitations on the Government at this time of economic challenge.

We recognise, however, that to address the upcoming demographic changes, Health of Older People will become an area of investment for governments into the future.

The Government acknowledges dementia as a key issue that for our country into the future we are committed to working to ensure people suffering from dementia receive quality services and live as good a life as possible - whether they live at home or in residential care.

Conclusion

The National government is committed to protecting and growing public health services - we have invested an extra $1.2 billion into health while we've been in office.

We are funding more services and more operations for older New Zealanders.

We now have over five hundred extra doctors and over a thousand extra nurses in our public health service than we did two years ago.

District Health Boards have been delivering more services to older people, with record numbers of people receiving home support.

In the past two years, we have increased the amount of home support being provided by more than 12 per cent to around 9,200,000 hours.

We are delivering more hours to the people who need it most, and we will be spending more money this year than we did last year.

This supports the Government's work to help people stay in their own homes for longer. That also means helping people to manage their own health conditions better.

I look forward to hearing more from you about the challenges you are facing and the opportunities you are taking to improve the lives of the older people in your care.

Thank you for what you do.

I wish you well for the rest of your conference.