Aging populations + Annual flu season = Difficult choices going forward?

[user1477391263]

I briefly said something about this on another thread.

Populations are aging rapidly all over the world---not just in the East Asian countries and Eastern Europe, but almost everywhere, from the UK to Brazil to Vietnam. We've long been told that this is going to create challenges going forward. I'm increasingly wondering if the COVID19 debacle is giving us a taste of the kind of difficult dilemmas we may face going forward.

Aging populations are going to massively, massively increase demand for healthcare---we know that. And in many countries, the number of people of working age is already shrinking. It's likely these trends will continue going forward. Fewer taxpayers to pay for healthcare systems. Fewer people to work as nurses, doctors, and other healthcare providers.

I don't know when the pressure of aging populations is really going to start to bite-five years, 10 years, 15 years from now? But as the pinch is felt, some of the dilemmas we've been acutely aware of recentlynot enough beds and staff for all the people needing caremight start making themselves felt during "non-pandemic" years as well-at least, during those years when flu is particularly bad.

We've dramatically decreased flu this year, but it appears to have taken social distancing and school closures (or, in Oz, NZ, Taiwan etc., heavy travel restrictions). We can't start doing this regularly. Apart from anything else, if we started doing these things every time we had a bad year, the misery they cause would be likely to have knock-on effects on the birthrate (further accelerating the aging population issue) and driving women out of the workforce (further accelerating the loss of taxpaying workers), not to mention making it hard to attract immigrants.

Perhaps we need to treat this year as a wakeup call and start thinking about what we are going to do about winter bed pressures, going forward? We need to try and think of low-disruption things (higher vaccination rates, better vaxes, some masking/hygiene stuff, handling as many things as possible through telemedicine) that will help us to cope. And also have those difficult conversations about how we can't live forever either.

I know this sounds like a conversation that can be shelved, but I'm reminded of the years before this pandemic hit. Scientists warned us for years that pandemics had not gone away and that we were almost certainly going to be hit by one---and when one did come, we were all a bit blindsided by it. I'm concerned that the aging population issue is also something that we are sort of "aware of" but not really planning for or thinking about with any sense of urgency.

Agree whole heartedly with you OP. We should be planning better.

I don’t really have any bright ideas though, apart from my very personal view that we need to keep looking at our assisted dying laws. I appreciate that is a very sensitive topic.

Ageing population of course presents many challenges but in terms of hospital capacity, one of the big differences between covid and anything else is that hospital staff has been catching covid too in such large numbers. They wouldn't normally be at risk of catching the same illness they are treating patients for, not on this scale anyway.

Most of the people in the hospital in Covid isn't old. They are those in their 50s and 60s. The death rate, however, is dominated by the very old. Prof Whitty said in one of the news conferences that we won't see a reduction in hospital pressure much younger groups are vaccinated.

I don't think in many definition we will call those in their 50s and 60s part of the aging population.

We hopefully won't see this pressure on beds once we got most of our middle aged adults vaccinated. They aren't the ones get serious flu and hospitalised.

I don’t really have any bright ideas though, apart from my very personal view that we need to keep looking at our assisted dying laws. I appreciate that is a very sensitive topic.

Looking at assisted dying laws in the context of pressure on limited medical support is not where I would like to see any society I live in headed.

Expanding healthcare capacity, preventative healthcare and lifestyle measures all good.

Agree with OP it needs to be discussed.

@Lumene oh I completely agree that it is not the answer to pressure on medical services and is indeed a quite separate issue, in terms of making decisions.

However, there inevitably would be a correlation between the two issues if more people were allowed to carry out their wishes in this country in the way they already are able to do by travelling abroad.

I would guess that massive number of redundancies (and increased automated jobs) will also affect amount of tax raised by the working population

@Exhausteddog

I would guess that massive number of redundancies (and increased automated jobs) will also affect amount of tax raised by the working population

Recessions/austerity aren't great for health outcomes either = even more pressure on services.

Another thing to look at is how well we age. If our lifestyles while younger are setting us up for chronic conditions and poor health in old age. Sedentary lifestyles, processed food, the connection between sugar and Alzheimer's, and gut health and inflammation, dealing with long-term stress, poor work-life balance, metabolic disease, addictions etc.

When I first lived in Hong Kong, it was strange to see so many elderly people out early morning doing Tai Chi in groups. So many of them. They were more flexible than me, yet 30 years older.
Getting older, being ill and having poor mobility don't necessarily have to go hand-in-hand. Or at least we shouldn't assume it's the norm. It would take a giant shift in attitude though.

They need to have free training for medical professional so people can train to be a nurse or a doctor without the worry of debts. Tie it in to a contract with working for the nhs for X number of years otherwise the debt would become payable.

That would help with training up people, also make it easier to access the training more training hubs, training both full and part time courses maybe people would become healthcare workers but cannot afford to quit jobs paying the bills to train a part time course although taking longer could help alleviate this.

With more staff we can have more beds to help treat people and get people seen faster for all types of illness so we don’t have 3/6 month long waiting lists for scans and whatnot.

I also think we do need to legalise assisted death for those who want it. We also need to stop believing in life at all costs everyone dies one day it shouldn’t be no matter the quality they must live it should be based on what quality they will have but that’s going to be a very hard pill for people to swallow.

I remember watching that tv show about deciding on if the child live or dies and doctors where saying years ago parents would be saying it’s time to let them go and be out of their suffering where as now they have to beg parents to see that nothing more is possible. It’s a harsh reality but we seem to of become stuck on the living at all costs.

We also need to stop pussyfooting around peoples poor choices. We could all be much healthier but people choose not to. Change Pe in schools so it’s not just all sport and add in thing like yoga/meditation etc.

Hear me out... there is a case for euthanasia.

Obviously a controversial issue, but somewhere like dignitas. I would be happy to sign a disclaimer that if I developed alzheimer's or severe dementia, didn't know who I was or who my family are or what day of the week it is, that I would be euthanized. Other would feel differently and that is fine, but I know a lot of people who have seen their parents or grandparents live through and eventually die from dementia, and its not living.

We also need to stop believing in life at all costs everyone dies one day it shouldn’t be no matter the quality they must live it should be based on what quality they will have but that’s going to be a very hard pill for people to swallow.
Agree with this.

@ChocOrange1

We also need to stop believing in life at all costs everyone dies one day it shouldn’t be no matter the quality they must live it should be based on what quality they will have but that’s going to be a very hard pill for people to swallow. Agree with this.

I agree with this too but likely to be flamed on here. I also don't think it's fair when it has an impact on the health and well-being of younger people too, I'm seeing this with my dad in his mid 60s and the impact of him being the carer for my extremely elderly and unwell grandparent is very upsetting. As is seeing my poor grandparent in such pain.

Three of my four grandparents have had (or are currently having) long, drawn out, painful end of life experiences. It's existing, not living and it's heartbreaking to see.

That and having known the loss of three family members in their 20s/30s to cancer has definitely informed my opinion that a lot of people are not very realistic about death. Particularly seeing Captain Tom's death described as 'tragic', no it is not tragic. It's sad for his family and for the people who knew him and loved him and who will miss him, but he lived to a be a fantastic age and it's nice to think he was actually able to do all those laps of his garden last year! Well done to him, a life well lived. But definitely not tragic.

@Lumene

Expanding healthcare capacity, preventative healthcare and lifestyle measures all good.

Yes to these. I think we should be looking at this already. In the younger age groups obesity is a big risk factor for hospitalisation but this message isn’t really getting out there. I actually started a thread recently about how patients are being described as ‘healthy’ because they have no underlying health conditions but they are clearly obese. I think this is misleading and isn’t doing us any favours. This is something that most people can take some control over to try to reduce their personal risk.

So easy to "blame" older people for their wicked /negligent lifestyle choices though I agree that most the pictures you see of severely ill covid patients are noticeably overweight.
Having said that it's true many things can be avoided by not being obese and keeping fit but there are no guarantees.
I was fit and healthy at 55, never overweight, did all the right things. I was diagnosed with an autoimmune disease and then cancer within five years. I watched my 85 year old mother decline into a painful, distressing and miserable death while dealing with cancer myself.

It made me determined to have an exit strategy as I thought of it. I do not want to end up like she did or have my children deal with what I did. Easier said than done.

It’s not about blaming the currently middle aged upwards it’s about making sure we fix it before the current young end up the same. It’s changing the mentally and putting better things into place.

Very much support dignity in dying (the charity and the idea). The money will not be there to care for all the elderly with dementia, illness and those who have just had enough - we have to be sensible and start talking about the implications for the country and the young if we continue to fund such ill elderly people. Of course you can live as long as you like but please stop rushing to save those who would be happy to just go. Death has to be normalised, we can't evade it. How can being bedridden, in pain, confused and lonely be called living it is existing only. Off track, any money I have I do not want to spend on nursing home fees but to say goodbye and help the next generation of my family. And before hospices are mentioned they do a wonderful job but we are talking about patients outside their remit.

The nhs dies not work on an all lives must be saved principle

All treatment is evaluated cost and years of high quality life

And basically you are saying that the rich will look after themselves but we won't look after the poor when we decide thier lives to be too expensive

Sooner or later almost everyone here will have a worse life if that attitude prevails

Because it won't stop at not supporting the elderly

@Roystonv

Very much support dignity in dying (the charity and the idea). The money will not be there to care for all the elderly with dementia, illness and those who have just had enough - we have to be sensible and start talking about the implications for the country and the young if we continue to fund such ill elderly people. Of course you can live as long as you like but please stop rushing to save those who would be happy to just go. Death has to be normalised, we can't evade it. How can being bedridden, in pain, confused and lonely be called living it is existing only. Off track, any money I have I do not want to spend on nursing home fees but to say goodbye and help the next generation of my family. And before hospices are mentioned they do a wonderful job but we are talking about patients outside their remit.

@Roystonv agree with every word of this.

P.s. it would be so reassuring to know that I can rely on being legally helped to die peacefully and painlessly instead of worrying about what an awful time might be ahead of me.

I really hope that all the research and money that has gone into vaccines during this pandemic means we are many steps closer to

1. more effective flu vaccines and 2) a universal flu vaccine (which will be more effective as it will work independently of which strain of flu it is).

Given the potential for influenza to cause new pandemics I think that final governments may decide that investing heavily in development of universal flu vaccines is worth the money.

Agree with choc.
But also build newer better hospitals with better infection controls. And rooms not wards.
How many do we make seriously ill when in hospital.
Think of a maternity ward in days of covid. Blergh!

I work in the NHS in strategy. An ageing population and winter pressures are both well-known issues.

It's not an issue that can be shelved and it's not an issue that is being shelved - it's my day job!

Healthcare is being slowly reformed to meet the needs of the future population. This is about far more than the spread of communicable disease. As you can imagine, it often feels like pushing water up a hill and more funding would help, but we don't need a wake up call!

Oh, and a simple and cheap measure - eliminate vitamin D deficiency in the UK population.
Fortification of foods, plus a clear public message to take the required dose for bodyweight to raise levels from deficiency. Then a clear message about maintenance doses to suit bodyweight.