Older Mind Matters

Ageing: both personal and political

Ricky Kanabar from the University of York presented a paper at the Royal Economics Society’s 2013 annual conference, which attracted some attention in the media (see the media briefing here). I wasn’t at the meeting, but reports say that he presented data taken from the English Longitudinal Study of Ageing on the phenomenon of ‘unretirement’ (people who retire then go back to work, often part-time). He argued that this could contribute significantly to the economy in future, and that perhaps government might consider ways to encourage this phenomenon. (I have a friend who I thought of as a serial retiree - now I know he's unretired!)

Alongside this we know that increasing numbers of people are not retiring and continue to work beyond what used to be recognised as the age of retirement. A report from the Office for National Statistics (see it here) found that the number of people working beyond state retirement age nearly doubled between 1993 and 2011, and is predicted to increase further following the abolition of a compulsory retirement age.

The House of Lords Select Committee on Public Service and Demographic Change published a report earlier this year called Ready for Ageing? This has more interesting stuff in it, but the short answer to the question is no: the government isn’t ready and as a society we aren’t ready. It talks about the need to change attitudes to ageing. Here’s a nice positive quote about the rising population of older people:

‘the contribution to our society made by older people, which is already impressive, will be even greater as a result’ (page 7).

One of the recommendations in the report is a piece of common sense:

“The inter-dependent nature of health and social care means that the structural and budgetary split between them is not sustainable: healthcare and social care must be commissioned and funded jointly, so that professionals can work together more effectively and resources can be used more efficiently.” (Page 13)

There is evidence that attitudes are changing and behaviours are changing too. The age at which people become ‘old’ (whatever that means) has shifted to later in life, at least for those who enjoy the benefits of good health and sufficient income. That still leaves us needing radical change in health and social care to refocus on those who need it most. And if we get the system right for the most needy, it’s likely to benefit everyone else as well.

3 comments (Add your own)

1. David Jolley wrote:
Well I guess I have been taken particularly by the first section of your blog on people who continue to contribute ‘work’ either by not stopping or by returning to work in the years allocated to ‘retirement’.
Those years might be defined by chronological age which we have become accustomed to designate ‘retirement’ through compulsory schemes associated with pension rights – often 60 plus for women and 65 plus for men. An alternative is the actuality of receipt of a pension on ceasing the regular work during which you have subscribed to a work’s pension scheme. This latter may be some years earlier than the traditional national pension age thresholds, and there remain arrangements for psychiatrists with Mental Health Officer status which have made this possible for quite a lot of people.

So why do people take that option and what do you do when you retire ‘early’?
Jim Amos shared his musings on the prospect and the responses of his wife http://thepracticalpsychosomaticist.com/2012/03/29/what-do-psychiatrists-do-when-they-retire/ with anticipation of more time for bird watching and gardening. They attracted few counter-blogs.
Eagles et al (2005) gathered the plans of 158 consultants in Scotland and most famously Brian Draper and colleagues (1997) surveyed Australian and New Zealand psychiatrists 55 years and older. Only 58 of Draper’s sample of 281 were actually retired but the remainder were anticipating what their lives would be and the reported findings relate mostly to professional activity within psychiatry. Reasons for retirement included age, fatigue, and memory difficulties. There was much reported planned and actual reading of journals but less actual writing, consulting, mentoring or attending meetings then had been anticipated. Hopefully people were content with the pattern of life which they created in the opportunity which well-paid retirement offers.

Perhaps this is one of the main points: the NHS pension scheme provides an income which places many of us still in the top percentage of earners so that anything which we do which might be deemed ‘work’ is already receiving a fair financial reward even if there is no fee for the services rendered. The great advantage of work in retirement is that you can devote time to what you want to give time to in proportions which reflect your personal values.
Of course you may feel that anything to do with psychiatry or healthcare has lost its interest and attraction for you, so you will do something else. But for me there remains much of interest, much which gives me pleasure and much to make me frustrated and angry in the matters of care of older people. There is unfinished business and I will use the time that I have strength and nous to continue to try to put these right.

There is general agreement that being active and doing things is associated with healthier and probably longer life, than sitting doing very little, though which is chicken and which is egg in these considerations is questionable www.devon.gov.uk/78755-better-health-old-age.pdf
The question of advantages and disadvantages of early retirement must also take into account confounders such as illness as a reason for the retirement www.bbc.co.uk/news/magazine-18952037
So there are many arguments that individuals are wise to take advantage of their retained abilities to further their own health and happiness, and probably those of the people who live with them. Some will choose to direct some of their activities to the endeavours which have gripped them throughout their lives.

The drift of the second part of your blog relates to dismay that the UK has got things wrong: older people are misunderstood and misrepresented as non-contributing burdens on the rest of the population, and the care from individuals and services to old people who do need help is scandalously poor.
You quote exhortations toward ‘radical change in health and social care to refocus on those who need it most’ and ‘healthcare and social care must be commissioned and funded jointly’

Detailing the phenomenon of unretirement amongst professional groups such as our own goes some way to countering the myth that old people are a drag on the rest of mankind. Of course there is massive evidence of the contributions of older people within family life and all sorts of social and entertainment activities from people of all backgrounds www.sqw.co.uk/file_download/332
One attraction of remaining involved with professional work in health or social care is the chance to contribute to thinking, planning and doing, and perhaps to influence policies, from the perspectives of both the workforce and the ‘retired’ population.
Though there are problems with what services do, I have never been impressed by calls for ‘radical change’. We have received these over and again from new ministers and new governments www.normanvetter.com/.
It will always be safer to make incremental change, retaining what is good and modifying the rest to achieve a new format which should be checked before moving on to something even better. I am deeply unimpressed with the call to merge (local, means-tested) social care budgets with the (national, more-or-less free) healthcare budget. These are two unlike elements and as with cloths of differing weave, they can be strong and support each other well when brought together with a robust seam. Attempts to mix their thread would produce a flawed and shapeless mess.
As we have demonstrated in our Gnosall experience and as confirmed in a recent review of Diabetes Services http://www.nao.org.uk/report/the-management-of-adult-diabetes-services-in-the-nhs/, doing things tidily within existing arrangements and budgets can achieve a great deal. Doing things less tidily and without flexibility is wasteful and unproductive

Mon, June 17, 2013 @ 1:48 PM

2. Derek Beeston wrote:
On reading you blog post 'Ageing:Both Personal and Political' about 'un-retirement' I remember a few years ago reading a very interesting and thought provoking paper called 'Beyond Therapy: Biotechnology and the pursuit of Happiness.' This paper was written by members of the Presidents Council on Bioethics in the USA, and its focus was on the likely broad ranging ethical, social and psychological consequences of possible future life extension technology. There is quite a lot of insightful discussion in the paper on the impact of the older workforce and of people choosing to stay at work well into old age (in this case -life extension of many decades beyond the three score years and ten). The paper can be downloaded from

http://bioethics.georgetown.edu/pcbe/reports/beyondtherapy/index.html

Mon, June 17, 2013 @ 2:15 PM

3. Ian Greaves wrote:
I met a very interesting lady from USA on one of my holidays. She was the partner of a prominent chief rabbi. Anyway, in america they have formmed a group called GREY MATTERS. This is to facilitate the continued engagement of older people both in the work place and in society in an altruistic way. We are looking at developing similar for health care professionals through our federation. early days but I think it would be good.

Mon, June 17, 2013 @ 2:33 PM

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