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How does Stormont plan to fund the cost of the ageing population?

The number of people living longer here is rising year by year. Ivan Little reports on the biggest-ever survey of our growing elderly population.

They’re calling it the greying of Northern Ireland - the age revolution which is set to see thousands more people living longer than the generations which went before them.

New figures show that by 2028 there will be more over-65s than under-16s for the first time. By 2027, the numbers of over 65s will jump by 44% and there’ll be twice as many people living beyond the age of 85.

And by the time 2062 comes around, it’s estimated that the proportion of over-50s will be around 45% of the population — a rise of 70% from 1982.

One consequence of an older population is expected to be a sharp and disturbing rise in the number of people suffering from dementia. Currently there are 19,000 people with the disease. By 2051 the experts reckon the number will be nearer 60,000.

It doesn’t however take a statistician to work out that the overall impact on society of a steadily ageing population is going to be profound.

The changes will provide major challenges for Government planners tasked with coping with a greater number of older people in relation to their growing health and social care needs, their family structures and the inherent financial implications for the future.

But in a bid to keep the Stormont strategists one step ahead of the age revolution, the biggest public health research project ever seen here is under way under the auspices of Queen’s University whose study team will be tracking the lives of thousands of over-50s as they grow older.

The study, which is similar to ones in Britain and the Republic, has the simple-sounding name of NICOLA (the Northern Ireland Cohort for the Longitudinal Study of Ageing). The principal investigator is Ian Young, a clinician who is also the professor of medicine at Queen’s University Belfast and director of the centre for public health.

But the study isn’t purely about health. It also focuses on the social and financial aspects of ageing, how people live and cope within communities, how they adjust to technology and how they maintain relationships with their families and friends.

“It is designed to help us to understand all aspects of ageing as it occurs now in Northern Ireland and how our past lives influence it and how we can inform policy so that ageing can occur most successfully and happily for as many as people as possible here,” says Professor Young (left).

Initially the study is looking at 8,500 people aged over 50. They are asked if they would be willing to take part and if they agree, the first phase of the study is an extensive 90-minute face-to-face interview. The subjects then get a questionnaire to complete.

The next part of the study involves a two-hour physical assessment carried out in the Northern Ireland clinical research facility, a state-of-the art suite of offices at Belfast’s City Hospital.

Professor Young says: “We put them through a fairly comprehensive assessment of their physical health, focussing on those aspects of the body which we think are particularly important to ageing — height and weight; how fat people are, blood pressure and lung function."

The aim is to encourage people who take part to feel part of the NICOLA family.

The professor adds: "The idea is that now people are members we will be in touch with them fairly regularly. We intend to check up on them every couple of years and follow them for the next 15 or 20 years."

So far, 1,500 people have been approached and the response has been positive, says Professor Young. "Several hundred people have been to the clinical research facility already and said they enjoyed the experience. It can be tiring, but it is good to sit down and talk to someone who is really interested in you and your views."

The study organisers hope that people who talk to them will give candid answers. But doctors and nurses generally assume that while most people will try to be truthful, many tend to underestimate their unhealthy behaviour, and overestimate their good behaviour.

For NICOLA to succeed, organisers say, it's important to include all sorts of people from all sorts of backgrounds in a non-judgmental way.

One spin-off which could arise during the physical assessments would be the discovery of significant health problems among the subjects. "We will let them know about it and that they need to go and talk to their doctors about it," says Professor Young.

Diabetes

One of the main focuses of the blood tests in the NICOLA study is a test for diabetes, which is becoming a more common problem here.

Professor Young says: "There are a lot of older people in Northern Ireland who have diabetes, but simply aren't aware of it because in the early stages it doesn't cause any symptoms which would make someone feel unwell and want to consult a GP as a result.

"Diabetes sees an increase in sugar in the blood and it's estimated that it affects 5% of older people. One of the things we will do if we find an increased sugar or glucose level in the blood will be to draw it to people's attention and tell them to go and have a thorough check-up with their doctor."

Cholesterol

The NICOLA volunteers are tested for the level of fats in their blood, particularly cholesterol, a name familiar to most people here. But Professor Young says: "A lot of people who have high cholesterol probably don't know anything about it. But again if we find dangerously high levels, we will recommend that participants go for a follow-up."

The eyes

The eyes may commonly be said to be the windows to the soul, but to medics they're also the windows to a myriad of ailments. Professor Young says: "We are looking in great detail at eye function because we believe that vision is really important to people as they get older because they have implications for all parts of their ability to work, to drive, to engage in leisure activities, to read and to watch television.

"We look for high pressure in the eyes – glaucoma, for example – and we have all sorts of sophisticated cameras and technologies which only exist in a small number of places in the world to look at the back of the eye."

The lungs

Special attention is also paid to the lungs during the assessments and breathing tests identify the fitness of people's lungs. Professor Young says: "We give feedback to people on the 'age' of their lungs, so a 53-year-old who breathes into our respiratory machine might have the lungs of someone who's significantly younger, but if they were a smoker they might have the lungs of a 67-year-old."

Diet

What people eat is on the menu for the NICOLA research team because that is central to so many diseases. Professor Young says: "People usually think about diet maybe in terms of heart diseases, but a substantial number of cancers can be prevented by having a healthy diet."

But the biggest challenge facing Northern Ireland, according to the experts, is obesity. "Around 70% of the over-50s here will be overweight or obese and that will present the risk of diabetes, heart diseases and strokes," adds Professor Young.

Despite the trends towards healthier food, the overall Ulster eating habits haven't caught up.

"Unfortunately, unhealthy foods taste nicer than healthy ones. I wish it was the other way around, but that's the truth. You can re-train your palate, but it takes time." But the obesity problems run deeper than just the quality of the food that we eat – it's also the quantity.

Professor Young says: "A lot of people eat too much and too often. And even if you have a pretty healthy diet. In terms of what you are eating, if you eat great big heaped piles of it you are still going to become overweight or obese.

"So as well as what you eat there are also questions over portion size. In many parts of Northern Ireland the main way people judge the quality of a meal in a restaurant is how the high the plate is piled. We need to move away from that sort of thinking."

Alcohol

Professor Young says the average adult in the UK takes 10-11% of their calories from alcohol. But people who imbibe more than the average amount of alcohol can easily get up to 20% of their calories or more from alcohol and that's why there is a strong link between weight gain and drink.

Physical activity

For some people in Northern Ireland, it's clear that much of the only exercise they get comes at the dining room table, eating their food.

But Professor Young says it's imperative that two hours of moderate physical activity should be part of everyone's weekly routine – like a minimum of 20 minutes brisk walking every day. He added: "You should also do two bursts of weight-bearing exercise like lifting light weights or doing sit-ups or press-ups."

Care

The NICOLA study is examining the question of care for the elderly. Initially it's only people who are living at home who are coming under scrutiny.

But Professor Young says: "As the population ages, some of the participants will move from living freely and healthily to living at home but needing the support of carers from within their own families or from outside professional services. In due course, some of them will need to live in residential facilities of different kinds.

"The study is looking in detail at those transitions in peoples' lives; why they occur; when they do and what sort of support people get as they grow older and how that could be done more effectively."

Loneliness and isolation

The NICOLA study will also concentrate on older people's interaction with family and friends or their loneliness. Professor Young says: "It's easy to focus only on medical things, but if you take a question as fundamental as 'Are you lonely?', a lot of older people begin to lose their friends and maybe become more isolated due to their families growing up or moving away. "It's important to understand the extent to which loneliness becomes a challenge to older people. And that can greatly reduce the quality of someone's life in all sorts of respects."

The high-tech world

Another aim of the study is to establish how older people are coping with the modern world of new technology, for example. The NICOLA team is trying to find out if participants have access to a computer and if they can use email or Facebook.

Professor Young says: "If they don't have that access, we ask them if they would like to have it and how we could support them if they do, because technology has become so important nowadays in all aspects of people's lives."

The results

The NICOLA study is being carried out with the main aim of helping the Stormont Executive to shape their policies for the future, to help the population age more healthily.

"We are trying to produce the evidence to feed into Government to assist them to do that, to influence policy and help them to plan for a Northern Ireland with a substantially greater number of older people," says Professor Young.

"It's about the whole breadth of ageing.

"But NICOLA is very wide in its scope and while we are concentrating on health, there are people from right across the university who are interested in anything that may have an impact on getting older in Northern Ireland."

The first results from the NICOLA questionnaires will be available towards the end of the year and then there will be an ongoing stream of reports with participants followed up over a minimum of 10 years.

The reports are expected to include suggestions for the Government as well as providing evidence and analysis of the data received during the study.

  • For more information email NICOLA@qub.ac.uk, or contact 028 9063 3078

So, is hitting 65 really so scary?

By Grainne McGarvey

Is 65 not the new 40? When I look at people I know in their 60s, I must admit 'old' or 'elderly' are not words that spring to mind.

As a 33-year-old, I have grown up in an image-conscious world that has created weird and wonderful ways to make us look and feel younger.

Just look at female movie stars like Olivia Newton-John (66), Goldie Hawn (68), and Meryl Streep (65) – all are still beautiful and energetic enough to give the young Hollywood starlets a run for their money, never mind being at the right age to draw their bus pass.

Don't get me wrong, it's not solely about looking younger. There are other issues associated with old age that I know will have a direct impact on my later life.

The extreme pressures now impacting our health and finance departments will undoubtedly mean that I won't have the same benefits as people currently aged 65. But does it keep me awake at night? No.

I still think 65 is young, in fact I still think 70 is young. And I suppose this is one of the reasons why I don't feel the pressure to plan too much for my old age.

Maybe I am a slightly different case from the norm – I went self-employed in 2010 so didn't have the luxury of disposable income or an employer willing to contribute into a pension.

The main focus for me this year has been to buy a house while prices are still relatively low, which I am hoping will set me up in the future and be my version of a pension pot.

What you forget as you get older is the fact that friends and family also get older, making health problems more of a reality.

Dementia is something that seems more prevalent among the parents and grandparents of people in my social circle. Is this a fear for me? Yes. This worries me more than the finances, as ill health is something that we can't fix, even if we work harder.

To end on a positive, though, I am lucky enough to have a great circle of friends, all around my age and who love keeping fit and active.

So, here's hoping that, in 2064, you will see a group of ladies in their early-80s marching around the Lagan towpath complaining that young people have never had it so good.

  • Grainne McGarvey is managing director of Belfast-based Pulse PR

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