Ageing and Disability: A Quality of Life Perspective

1
Ageing and Disability A Quality of Life
Perspective
Alan Walker Professor of Social Policy and Social
Gerontology University of Sheffield, UK and Carol
Walker Professor of Social Policy University of
Lincoln, UK
European Association of Service Providers for
Persons with Disabilities (EASPD) Conference on
Ageing and Disability, Graz, 8-9 June, 2006
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Ageing and Disability A Quality of Life
Perspective
ROAD MAP

• Ageing and Disability in Europe
• Gerontological Evidence on Quality of Life
• Policy Priorities for Quality of Life

Alan Walker, EASPD Conference on Ageing and
Disability, Graz, 8-9 June 2006
3
Ageing and Disability A Quality of Life
Perspective
Ageing and Disability in Europe
Alan Walker, EASPD Conference on Ageing and
Disability, Graz, 8-9 June 2006
4
Alan Walker, EASPD Conference on Ageing and
Disability, Graz, 8-9 June 2006
5
The Ageing of the European Population
Alan Walker, EASPD Conference on Ageing and
Disability, Graz, 8-9 June 2006
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Ageing and Disability A Quality of Life
Perspective
The Negative Myths About Ageing Societies

• Ageing means more spending on health, social care
  and pensions
• A simple correlation between ageing and
  disability ageing means more disability

Alan Walker, EASPD Conference on Ageing and
Disability, Graz, 8-9 June 2006
7
Ageing and Disability A Quality of Life
Perspective
Ageing and Disability

• Current prevalence rates
• Projections
• The compression of morbidity

Alan Walker, EASPD Conference on Ageing and
Disability, Graz, 8-9 June 2006
8
Age and Functional Limitation - EU 15 1998
Alan Walker, EASPD Conference on Ageing and
Disability, Graz, 8-9 June 2006
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Ageing and Disability
Disability rates for EU 15 (1999)
Proportion reporting a physical, sensory or mental disability 23
Of whom reporting severe disability 8
Proportion 75 reporting a physical, sensory or mental disability 45
Of whom reporting severe disability 27
Alan Walker, EASPD Conference on Ageing and
Disability, Graz, 8-9 June 2006
10
Alan Walker, EASPD Conference on Ageing and
Disability, Graz, 8-9 June 2006
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Alan Walker, EASPD Conference on Ageing and
Disability, Graz, 8-9 June 2006
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Dependency Projections 2000-2050
Growth in Numbers of Older People with Dependency Growth in Numbers of Older People with Dependency Germany Italy Spain UK
1. Constant dependency rates 121 107 102 87
2. 1 year rise in life expectancy delays dependency by 0.5 years 73 41 79 61
3. 1 year rise in life expectancy delays dependency by 1 year 34 -1 56 35

Alan Walker, EASPD Conference on Ageing and
Disability, Graz, 8-9 June 2006
13
Ageing with an Intellectual Disability

• Absence of standardised data
• 2.3 of the population of the EU 15Range 1.9
  France, Sweden - 3.4 Spain
• Projections 1995-2020 60 77 increase lt15
  62 increase

Alan Walker, EASPD Conference on Ageing and
Disability, Graz, 8-9 June 2006
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Ageing and Disability A Quality of Life
Perspective
Gerontological Evidence on Quality of Life
Professional vs. Lay Concepts
Alan Walker, EASPD Conference on Ageing and
Disability, Graz, 8-9 June 2006
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Core Life Domains
Household Composition Education Labour Force
Participation Household Income and Financial
Resources Living Standards and Ability to
Participate Health Status Family Life Community
Life and Social Participation Other Domains
eg. housing tenure, life satisfaction Fahey,
Nolan and Whelan, 2002
Alan Walker, EASPD Conference on Ageing and
Disability, Graz, 8-9 June 2006
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Evidence from the UK Growing Older Programme
http//www.shef.ac.uk/uni/projects/gop/
Alan Walker, EASPD Conference on Ageing and
Disability, Graz, 8-9 June 2006
17
The Foundation of a Good QoL in Old Age

• having good social relationships with family,
  friends and neighbours
• having social roles and participating in social
  and voluntary activities, plus other
  activities/hobbies performed alone
• having good health and functional ability
• living in a good home and neighbourhood
• having a positive outlook and psychological
  well-being
• having adequate income
• maintaining independence and control over one's
  life.
• Source Bowling et al (2002)

Alan Walker, Current Research in Gerontology and
Social Policy, Hong Kong Baptist University, 26
April 2006
Alan Walker, EASPD Conference on Ageing and
Disability, Graz, 8-9 June 2006
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Maximising Quality of Life

• Maintaining health and independence, social
  activities and relationships,
• Neighbourly and safe areas,
• Local amenities and services,
• Participation,
• Transport,
• Finance.
• Source Bowling et al (2002)

Alan Walker, EASPD Conference on Ageing and
Disability, Graz, 8-9 June 2006
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The Magnificent Seven
Alan Walker, EASPD Conference on Ageing and
Disability, Graz, 8-9 June 2006
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Ageing and Disability A Quality of Life
Perspective
Policy Priorities for Quality of Life

• Employment
• Maintenance of Health and Autonomy
• Care and Carers
• Social Inclusion/Participation

Alan Walker, EASPD Conference on Ageing and
Disability, Graz, 8-9 June 2006
21
Employment Ratio Among Disabled and Non-Disabled
People
Alan Walker, EASPD Conference on Ageing and
Disability, Graz, 8-9 June 2006
22
Demographic Characteristics of Disabled and
Non-disabled Working Age Population ()
Disabled Non-disabled
Age (years)
16-24 6.4 17.0
25-34 12.6 25.5
35-44 17.7 23.6
45-54 24.9 19.0
55-64 38.4 14.9
Gender
Male 47.3 48.9
Female 52.7 51.1
Educational level
Low 52.7 42.7
Medium 34.5 39.2
High 12.8 18.1
Source ECHP, 1996
Alan Walker, EASPD Conference on Ageing and
Disability, Graz, 8-9 June 2006
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Major Chronic Conditions Affecting Older People

• Cardiovascular Diseases (eg. coronary heart
  disease)
• Hypertension
• Stroke
• Diabetes
• Cancer
• Chronic Obstructive Pulmonary Disease
• Musculosketal Conditions (eg. arthritis,
  osteoporosis)
• Mental Health Disorders (eg. depression,
  dementia)
• Sensory Impairment

Source WHO (1998)
The Contexts of Care The Places of Care History
and Outlook from XV to XXI Century, Turin, June
18-20th, 2004
Alan Walker, EASPD Conference on Ageing and
Disability, Graz, 8-9 June 2006
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Scope of non-communicable diseases prevention a
life course approach
Infancy andchildhoodSESdiseasesgrowth rate
AdolescenceObesitylack of PAsmokng
Adult lifeEstablished adult Behavioural/biologi
calrisk factors
Fetal lifeSESmaternalnutritionalstatusbirt
hweight
high Accumulated risk (range) low
Development of NCD
Age
ES socioeconomic status PA Physical
activity Source Aboderin et
al., 2002, p.17
Alan Walker, EASPD Conference on Ageing and
Disability, Graz, 8-9 June 2006
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Proportion of Disease Burden (DALY) Attributable
to Risk Factors (all ages)
EU 25
Smoking 9.0
Alcohol use 8.4
Vegetable/fruit deficiency in diet 3.5
Overweight 3.7
Fat content of food 1.1
Physical inactivity 4.4
Relative poverty 3.1
Work environment 3.6
Alan Walker, EASPD Conference on Ageing and
Disability, Graz, 8-9 June 2006
26
Unfortunately and incorrectly people with
potentially disabling conditions often are not
recognised as a target population for primary
prevention effort, despite the fact that having a
potentially disabling condition frequently
increases the need for good health promotion and
disease prevention practices.
Pope and Tarlov, 1991, p.105.
The Contexts of Care The Places of Care History
and Outlook from XV to XXI Century, Turin, June
18-20th, 2004
Alan Walker, EASPD Conference on Ageing and
Disability, Graz, 8-9 June 2006
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Prevalence of Care Dependency in EU
Alan Walker, EASPD Conference on Ageing and
Disability, Graz, 8-9 June 2006
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Projected Increase in Numbers of Older People
Receiving Formal and Informal Care 2000-2050
Germany Spain Italy UK
Numbers receiving informal care 119 100 109 72
Numbers receiving home-based care 119 99 119 92
Numbers receiving institutional care 127 120 81 102
Growth in expenditure 120 115 96 102
Expenditure as GDP in 2050 2.72 1.39 1.94 2.75
Alan Walker, EASPD Conference on Ageing and
Disability, Graz, 8-9 June 2006
29
Age Distribution of Carers in the EU 25, 2005 and
2030 ()
2000 2000 2030 2030
Age Carers providing 20 hrs pw Carers providing 35 hrs pw Carers providing 20 hrs pw Carers providing 35 hrs pw
25-49 38 38 29 29
50-64 38 38 39 39
65 24 24 31 32
Alan Walker, EASPD Conference on Ageing and
Disability, Graz, 8-9 June 2006
30
Exclusion by self-assessed general physical health
Alan Walker, EASPD Conference on Ageing and
Disability, Graz, 8-9 June 2006
31
Exclusion by depression status (CESD
questionnaire)
Alan Walker, EASPD Conference on Ageing and
Disability, Graz, 8-9 June 2006
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Responding to the Policy Challenges
Key Policy Directions

• Combating age/disability barriers to employment
• Active ageing promotion of health and well-being
  across the life course
• National strategies for ageing carers
• Promoting social inclusion national and local
  policies

Alan Walker, EASPD Conference on Ageing and
Disability, Graz, 8-9 June 2006
33
Ageing and Disability A Quality of Life
Perspective
Key Messages for Service Providers

• Combat ageist stereotypes (eg. age awareness
  training)
• Base support on ability and potential not
  disability
• Maintain aspirations and expectations regardless
  of age
• Retain the goals of inclusion, participation and
  choice
• Initiate health promotion it is never too late
• Treat disabled people and their family carers as
  equal partners in planning their lives
• Provide a single point of contact with advice on
  services and social protection
• Instill a service philosophy based on consistent
  principles such as social inclusion, empowerment
  and normalisation

Alan Walker, EASPD Conference on Ageing and
Disability, Graz, 8-9 June 2006
34
Ageing and Disability A Quality of Life
Perspective
ROAD MAP

• Ageing and Disability in Europe
• Gerontological Evidence on Quality of Life
• Policy Priorities for Quality of Life

• Conclusion

Alan Walker, EASPD Conference on Ageing and
Disability, Graz, 8-9 June 2006
35
Ageing and Disability A Quality of Life
Perspective
THE END THANK YOU
Alan Walker, EASPD Conference on Ageing and
Disability, Graz, 8-9 June 2006