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Living conditions as they are now for
ageing people with a disability and the
living conditions for all ageing persons
EU – Perspective
Barbro Westerholm, Prof., Vice
President AGE
Graz June 8, 2006
During the past century the average life
expectancy of Europeans has increased by 28
years, from 45 to 73 years
This is a victory!
Demographic changes 60+, 2000 - 2050
EU 22% - 40%
Austria 20% - 40%
Belgium 22% - 38%
Denmark, Finland, Sweden,
Luxemburg 20% - 36%
France, Portugal 21% - 38%
Germany 23% - 40%
Great Britain 21% - 37%
Greece 23% - 41%
Ireland 16% - 39%
Italy 24% - 44%
The Netherlands 19% - 37%
Spain 22% - 44%
Definition of ”older people”
• 50 + ?
• 60 + ?
• 65 + ?
Older people are individuals who differ from each
other. The diversity should be acknowledged
and leads to different needs
Older people are young people who have lived for
some time
Chronological age is misleading!!!
Living conditions of older people in the EU,
needs and desires
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Access to
work/ adequate pensions
social networks
adequate housing
adequate nutrition
transport, communication, environments
education
cultural activities
health promotion
health care of high quality
palliative care
support to family carers
Needs and desires continued
• Social integration, participation
• Interest representation
• Freedom from crime/violence/abuse
Definition of disability
World Health Organization: A disability
(resulting from an impairment) is a
restricted ability to perform an activity in
the manner or within the range considered
normal for a human being
Disabilities in old age – how common?
• EU statstics say that women can expect to
live 66 years and men 63 years without
any disability
• Almost one in four elderly people describe
their health as bad, women more often
than men
• Around six million Europeans are affected
by dementia
Many of the added years are
healthy years but…
• Approximately 20% of people aged 70
years or older and 50% of people aged 85
and over, report difficulties in such basic
activities of daily living as bathing,
dressing, toileting, continence, feeding,
and transferring from chair to bed.
• Women report more difficulties than men
Causes of disabilities in old age
• Congenital – anatomical, physiological or mental
abnormalities
• Diseases, especially multiple diseases
• Injuries
• Impairments – anatomical, physiological or mental
abnormalities)
• The disablement process is modified by factors related
to life style, the availability and use of services, ageing
processes and characteristics of the social and physical
environment (Disability in old age, Burden of Disease Network
Project 2004, BURDIS)
Disability: policies for people with
special needs (1)
• The EU approach to disability does not identify separate
categories of people, it is instead based on individual
needs. This is a much more socially-inclusive approach
than one based on cagegorisation. It implies a general
shift away from disability-specific programmes towards a
manistream approach.
• The goal is to ensure that people with disabilities enjoy
the same human rights as everyone else, by removing
barriers and combating all forms of disability-related
discrimination.
Source: The social situation in the European Union
2004, European Commission
Disability: policies for people with
special needs (2)
• Trends in EU-15 countries are generally
positive in this area, although several
obstacles remain, where much more effort
is still needed – notably physical, legal and
administrative barriers, new technologies
and attitudes
Disability: policies for people with
special needs (3)
• Barriers:
In many new Member States disability policies
still tend to be oriented towards segregation
rather than mainstreaming action across all
policy areas. Moreover, although quota systems
are prevalent, there appears to be major
problems with their practical enforcement.
Disability policies in these countries are only
now beginning to move away from the old-style
`protectionist`policies and medical models of
disability
Disability: Policies for people with
special needs (4)
• Problems: The movement away from
sheltered employment has, initially led to
higher unemployment for people with
disabilities: so far it has not yet been
compensated for by the necessary
supportive policies and mainstream
employment opportunities for disabled
people, who may not possess the
education, experience or training to be
employable in the open labour market.
Disability: policies for people with
special needs (5)
• Problem:
In addition the focus on reasonable
accommodations for disability in the
Employment Equality Directive has not yet
filtered through to policies and practices in
new member states
Green paper on Mental Health
2005
• ”Promoting mental health in older people
An ageing EU-population, with its associated
mental health consequences, calls for effective
action. Old age brings many stressors that may
increase mental illhealth, such as decreasing
functional capacity and social isolation. Late lifedepression and age-related neuro-psychiatric
conditions, such as dementia, will increase the
burden of mental disorders. Support
interventions have shown to improve mental well
being in older populations”
Mapping existing research and identifying knowledge gaps
concerning the situation of older women (and men) in
Europe (MERI)
www.own-europe.org
• Greece
• Austria
• Italy
• Belgium
• The Netherlands
• Finland
• Portugal
• France
• Spain
• Germany
• Sweden
• Great Britain
MERI
Sorces – research and public
statistics
Findings
• General conclusions:
Despite the fact that women live longer they
more often suffer from disabling diseases
and disabilities and therefore are more
dependent on help than men. If they are
disabled they more often live alone than
men
MERI – some country findings (1)
• Austria – Whereas older women aged 50
– 69 are less likely to suffer from hearing
impairments than men of respective age
group, the ratio changes considerable for
the age groups 70 – 79 and 80+.
Women 60+: the most commonly reported
diseases are varicose veins, thrombosis,
phlebitis, rheumatism, slipped discs and
osteoporosis
MERI – some country findings (2)
• Belgium: Serious health problems and the
consequent disabilities, men are affected more
frequently than women
• Finland: Functional capacity of the elderly, both
men and women, have improved markedly
during the past 20 years. Persons with higher
than basic education have fewer ability limitation
than others. Disability pension applications
submitted by women are rejected more ofthen
than applications submitted by men.
MERI – some country findings (3)
• France: Women are more prone to
illnessess and disabilities and
consequently to dependency.
Paradoxically, they use fewer appliances
and prostheses, etc. The explanation for
this is that technical aids (glasses, hearing
aids, crowns and dental implants etc) are
often only barely covered (if at all) by
health insurance.
MERI- some country findings (4)
• Italy: The number of older disabled women is
almost double than that of older disabled men
(65+ 67.7% vs 39.5%). The psychological
condition of disabled women is much more
critical than that of men in the same situation.
• The Netherlands: Differences in functional
limitations and impairments (e.g. sight and
hearing) are unfavouralble to older women and
stresses the need for gender-specific
registration and classification systems in health
care.
MERI – some country findings (5)
• Spain: The high prevalence of chronic diseases
(arthritis, heart pathologies, cerbro-vascular
accident and dementia) among older women
with disabilities has a consequence the need for
help care (daughters, spouses and other
relatives)
• Sweden: Many symptoms, disorders and
disabilities are found to be more common in
older women than men BUT the results of the
research are not being used to the extent they
deserve
MERI- some country findings (6)
• United Kingdom: Physical
disorders/disbilities was the area best
covered in most studies, eg difficulty with
eyesight, hearing, mobility, self care and
domestic tasks. Mobility is described in
terms whether a range of particular tasks
cannot be undertanken at all, whether the
person can usually manage the task with
help, and the use of mobility ades.
Disability prevention, interventions and
research. Recommendations by the BURDIS network
(2004)
• Trials aimed at prevention of disability in old age
should be given priority
• Standard criteria should be developed and
validated for the identification of older persons at
risk of disability from a life course perspective
• Multi-component interventions need to be
developed and tested
• Research into the roles of environmental factors
(social, physical, economic, cultural and political
domains) should be strengthened
Development of health and social services
(BURDIS Network 2004)
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Comprehensive geriatric assessment
Preventive home visits
Health promotion
Screening for frail people in the community
Home care,
Management of chronic diseases
Medication !!!
Councelling
Adequate housing and pensions
Creating accessible environments
Preventing prejudice and diskrimination
What about the NGO:s
• European level – does not pay special interest to older
disabled persons
• Sweden – umbrella organisation – has reacted against
the fact that a Swedish parliamentary committee
SENIOR 2005 has only briefly described the needs of
older disabled people
• Individual Swedish organisations who do pay interest:
• NGO – mental handicap
• NGO – polio patients
• NGO – diabetes
• NGO -- hearing
Key issues
• Statistics and research on the living conditions for all
ageing persons including the disabled have to be
developed both on national and European level
• Research on determinants of disabilities in old age has
to be prioritized
• Interventions for the prevention of old age disabilities
have to be developed
• The access to adequate housing, accessible
environments, social networks, adequate pensions,
gerontologic and geriatric competence, rehabilitation,
screening, home care, optimal medication, adequate
nutrition etc has to be improved
• Freedom from abuse and discrimination
Final reflections
• Our knowledge about the size and
composition of older disabled people is
incomplete – is mainstreaming one of the
causes?
• Policies for older people and disabled
people should not be separated by walls,
there are areas where they have much in
common