Thursday 23 January 2020

Patricia Casey: 'This could be the roaring 20s, or a decade that sees the doctor become the executioner'

Elderly man struggling to read his phone. Stock picture
Elderly man struggling to read his phone. Stock picture

Patricia Casey

Think back to 2010 and how the past 10 years had whizzed by. Most of us will remember that decade for the financial depression that was just embedding itself into our society.

People were being laid off work and houses were repossessed by the banks. Nama had just been established to deal with the fallout. The building industry was grinding to a halt, triggering massive unemployment, reaching levels of up to 11pc. Ghost estates were dotted round the country and large building projects with towering silent cranes were emerging, silent and surreal, as in the empty cities of China. Fianna Fáil was still in government and in the UK Gordon Brown, with his Labour government, had just lost the reins of power, a defeat that has had repercussions up to the present.

When this new decade, just a few days old, will have flown by with even greater velocity and we celebrate 2030, a whole new set of realities will have emerged. This new year is full of speculation about many of these obvious and visible changes. Some, like self-driving cars, are very likely to become a reality. Further steps towards reaching Mars will have been made while, if we believe the UN Intergovernmental Panel on Climate Change, we may be facing drought, flooding, extreme heat and poverty for millions across the globe. But that's a worst-case scenario.

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However, the most momentous change will be a silent one. Massive demographic changes are already transforming Europe as populations age and fertility decreases. This has spawned shortages of workers and depopulation in rural areas along with housing crises in urban belts due to migration.

In Ireland our population continues to increase, particularly in the Greater Dublin Area with over quarter of a million more expected to live there in the next decade. Nationally our population is predicted to increase to slightly over five million by 2031. It will comprise two broad groups; those who are working and those who are not (minors and the over 65s). These are classified as dependants.

The ratio of those who work to those who are dependent is an important statistic, as it gives an idea as to the magnitude of the financial stress a country will be under. In Ireland, the dependency ratio overall is predicted to increase from 49.2pc in 2011 to 56.8pc in 2031 and for the over 65s from 17.3pc to 30pc or almost one million. The number under 15 will decline.

So the increase in population will not bring about an increase in the working population but in the non-working, older age groups. According to the CSO this model takes account of migration, although the level of this in the future is uncertain. These are more than cold statistics as they have huge implications. For example, the decline in the numbers of young people has implications for the provision of educational facilities.

In particular, the problems finding school places may be lessened, so that the annual beginning of year debate about school places may become muted. On the negative side the likely numbers emerging into the jobs market, the taxpayers of the future, will also diminish with implications for funding in diverse areas from social services to roads.

At the other end of the age spectrum, one million elderly people will potentially place a massive strain on pension funds and on health services. This, of course, may be offset to some extent by a healthier ageing population and one that may be still in employment past the usual retirement age.

I am struck by the mental health problems associated with the enforced retirement at the age of 65. This is changing with an increase to 67 by 2023 now planned for those who so wish. Not only will this benefit the coffers of the country, but also assist the mental health of older age group. The trend, already obvious, for people to remain fit and healthy into their 80s is likely to continue with the average life expectancy, now at 78.4 for men and 82.8 for women.

This may not increase much further as it has recently plateaued throughout Europe. The strain that our increasing elderly population will place on the health services has yet to be calculated. This will include not just acute hospital services for the elderly, but longer-term facilities like day care and nursing homes as well as home-based carers. The private sector is also likely to show an interest in up- market retirement villages with a range of sports and entertainment facilities and the grey pound will be courted.

There is also a danger that ideology will rear its unwelcome head with calls for assisted suicide and even euthanasia as a means of easing the financial and health pressure on hospital and other beds. Holland and Belgium are to the fore in promulgating death for the very ill and the very old who are in poor health.

Promoted as dignity and compassion, such a scenario would place intolerable pressure on vulnerable people with little voice to concur with demands to take the lethal "Soma" so as not to be a burden. And for those with no voice, particularly with dementia, the doctor would become the executioner. These issues are not just fanciful but will play out in our everyday lives. The 20s may be fun filled like the roaring 20s a century earlier, allowing us to enjoy life to the full into old age, or the 20s may be the decade that decides that old people as expendable when they are past their dancing year.

Irish Independent

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