The importance of EQUAL
5. It is well known that, although the United Kingdom
already has an aged population, the number of older people will
rise markedly over the next thirty years, as the post-war 'baby-boom'
generation ages. Perhaps more importantly, the proportion
of older people in the population will also increase, as a result
of continuing low projected fertility rates and rising life expectancy.
These trends are common to developed societies across the globe
and not unique to the United Kingdom. Indeed there are recent
suggestions that official projections may be under-estimating
life expectancy, with a new mortality forecast suggesting that
"by 2050 the populations in these countries (the G7 nations)
may be living from 1.3 years (UK), to 8 years (Japan) longer than
official estimates now predict".[10]
Moreover, the recent completion of the first stage of the human
genome project raises the long term prospect of even longer life
expectancy.
6. Increased life expectancy is something of which
societies can be proud. In the past such increases were largely
the result of improvements in living standards, in public health
and particularly in the control of infectious diseases, the environment
and medical care in infancy. More recently the effects of these
improvements have been increased by better medical care and higher
standards of living in late middle and old age. In fact, the United
Kingdom may not have cause for as much pride as some other countries.
For example, while life expectancy at age 65 in the United Kingdom
has risen to 79.8 years for a man and 83.3 years for a woman,
the equivalent figures for the USA are 80.9 and 84.4 years. Our
life expectancy, as currently projected, is lower than that for
people living in countries such as France and Japan.
7. Although life expectancy in later life has improved,
healthy life expectancy has not risen to match it. As a
recent overview states:
"Life expectancy at birth has greatly increased
(in developed societies) over the last thirty years while the
overall value of life expectancy without disability or handicap
¼ seems
to have remained the same.".[11]
This is the stark reality: for all our success
in increasing life expectancy, we have failed singularly to extend
the length of healthy life.
8. There is still debate, however, about whether
the level of disability which continues to afflict the older population
is in itself changing. There is evidence that there has been an
increase in mild levels of disability but a decrease in more severe
disability. Although this has become the general consensus, recent
findings for Britain show that there has been an increase in the
prevalence of more severe disability.[12]
Worryingly, the authors of the study found that:
"The prevalence of disability reported in the
1996/7 (Disability) survey was much higher than in the earlier
1985 survey of disabled adults in private households. None of
the methodological differences we were able to examine accounted
for this".[13]
There was no "suggestion of greater relative
increases in mild rather than more serious disability, except
in the eighty and over age group".[14]
For, with increasing life expectancy also comes an increase in
incidence of late-onset disabling conditions and diseases such
as for example Alzheimer's Disease, and other chronic degenerative
diseases of the brain and musculo-skeletal system. These are now
imposing greater burdens on individuals, families and society.
9. The evidence that the extra years gained include
extra years of disability (whether milder or not) is what makes
initiatives such as EQUAL so important. The evidence raises
the questions of how we can afford to provide for an increased
proportion of older people who may need health and social care
and whose later years may be dogged by low quality of life, and
of how we can lessen this disability and improve people's lives.
It is the latter question which EQUAL was set up to address.
10. According to the OST, the period "during
which individuals and groups of people may expect to enjoy active,
fit and participative lifestyles" can be extended through
—
"harnessing a broad range of science and engineering
outputs to overcome the mental, physical or other disabilities
which are affecting an increasing number of people due to this
expansion in the elderly population.".[15]
The assumption behind this initiative is that the
United Kingdom had not previously been harnessing these outputs
adequately and needed a more focused approach to research. Some
of those who gave evidence to us admitted this. The Economic and
Social Research Council (ESRC), for example, told us that, despite
some pre-EQUAL initiatives on its part, "UK social science
has under-invested in research on ageing compared with the United
States and some of its EU partners".[16]
There are, for instance, several well-established gerontology
research centres in France and Germany and a more recently announced
research programme on ageing in Finland has been allocated nearly
£2 million over two years.
Areas of research relevant to
EQUAL
11. To extend the active period of people's lives
may mean improving their physical or social environment or the
individual's physical and psychological characteristics (or the
relationship between the two). First, there is a need for research
to investigate the causes of low quality of life and determine
what should be done and how to improve it. After that come alterations
in, and developments of new, services, facilities, products, treatments,
and programmes together with the careful evaluation of innovations.
EQUAL so far has concentrated on the first area, but has included
some developmental work.
12. The major relevant areas for research are —
(a) the fundamental
biological processes of ageing;
(b) risk factors and causes, appropriate treatments and effective
means of prevention or amelioration of diseases of later life
(psychological, neurological and physical; both minor and major
diseases);
(c) measures to promote healthy behaviour and life-styles;
(d) measures to rehabilitate people experiencing ill health
or disability;
(e) the prevalence and nature of age discrimination in health
and social care, and how such behaviour and attitudes can be changed;
(f) the contribution of support services to extending quality
of life;
(g) the influence of social and economic factors and the social
environment on the quality of older people's lives; for example,
financial well-being, participation in community activities, family
structure and behaviour, education, employment; and
(h) development of health- and independence-related equipment
designed for older people, eg. monitoring equipment, rehabilitation
devices, housing adaptations.
13. Research in these kinds of fields almost inevitably
requires a multi-disciplinary approach, since there are such close
connections between, for example, health, morale and activity,
income, well-being and use of services. Differing methods will
also be necessary; some of the research questions may be addressed
by short-term experimental or survey approaches; others will require
a longer timescale (for example, a longitudinal survey) or a multi-site
design. We welcome the English Longitudinal Survey being led by
University College London, but find it bizarre that it is being
50% funded by the US National Institute on Aging, with less than
50% by UK Government Departments.
14. An area which has been neglected in the past
is the needs of older people from ethnic minorities. We welcome
recent research that has been done to identify the particular
needs of older people from black and ethnic minority communities.
Future research into ageing must take ethnicity fully into
account.
15. EQUAL provides the potential to focus research
and development on the growing need of an ageing society for improvements
in quality of life in later years. There is a pressing need for
research directed both towards those who are already old, and
towards the next generation, particularly those in their 40s and
50s whose old age we may be able to improve significantly.
7 Department of Trade and Industry Press Notice, 20
July 1995, P/95/487. Back
8
Ibid. Back
9
Ibid. Back
10
Tuljapurkar S, Li N & Boe C (2000): A universal pattern
of mortality decline in the G7 countries, Nature, pp 405,6788,
789-792. Back
11
Robine J-M, Romieu I & Cambois E (1997): Health expectancies
and current research, Reviews in Clinical Gerontology, pp
7, 73-81. Back
12
Grundy E, Ahlburg D, Ali M, Breeze E and Sloggett A (1999). Results
from the 1996/97 Disability Follow-up to the Family Resource Survey,
DSS, Research Report No. 94. Back
13
Ibid. Back
14
Ibid. Back
15
Evidence, p 28, paragraph 3. Back
16
Evidence, p 81, paragraph 7. Back
