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.

A more radical approach would be to privatise the NHS and run it in a similar way to some of the European health services. When you place a value on your health you tend to take more care of it.

NHS dentistry is subsidised but is mostly funded by the patient. It has been predominantly a screening and preventative service for the last 30 years. I’m not suggesting a pay as you go system but some form of salary based contribution that is specific for healthcare with a small charge at point of access to give healthcare value.

Data proves that there has been massive improvement in the nations dental health partly driven by social trends and advertising campaigns by pharma companies selling the dream ( the white smile),but also because if you neglect your mouth it costs money to fix.

Most 60-70yr olds have most of their own teeth. When I started in practice pretty much everyone I saw over 50 had a full set of dentures or very few teeth of their own.
But we are seeing a massive increase in disease in children which is diet related. It may be an indicator of general population health for that age group. It’s generally associated with child obesity. So while some pp are moaning about the boomer generation, they are probably healthier than the up and coming generations will be, which may be why they are living longer. Our current average lifespans are likely to decrease over the next few generations unless we start to address the obesity issue.

I agree with normalising death. I lost my parents quite young and really struggle with the idea of all these tragic deaths of apparently fit and healthy 80+ individuals with years to live. Sir Tom had an incredibly full life and spent Xmas in Barbados. I am angry that his life is deemed more important than anyone else who has died as a result of Covid.

angrymum

No one has suggested Captain Tom's life or death was more significant than anyone else's. His full life was frequently mentioned. People felt like they knew him because he had done a remarkable thing, so his death was felt by many. I'm afraid your response says a lot more about your own issues than anything wrong with the nation's attitude to death.

It's disgusting to suggest death should be normalised in the context of not offering treatment.

Masks and social distancing might become normalised in the winter to deal with this.

I think masks in very crowded areas during flu season is a reasonable idea, but "social distancing" to me implies stuff like school closures. Society cannot start shutting schools down every time bed pressures start to bite!

@alliejay81

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!

This post is worth repeating!

@midgedude

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 this.

This idea that we have to have "difficult conversations" about not living forever - what do people actually mean when they say things like that? What are the real life situations that people see being handled differently than they are currently, and how do they see this happening in practice, in detail?

Can you give an example of a patient you would not offer treatment to and how this would play out in practice, the conversations you would have, what care they would get if any and who would give it? (You can't just pick extreme examples like a frail 90 year old not being ventilated, because that already doesn't happen.)

Are you talking about, say, withholding treatment from 70+ patients with dementia who need antibiotics for something? Not treating cancer in people over a certain age who could recover from it?

An abstract musing about how we're somehow keeping too many people alive too long is really easy to come out with. Just saying "people like this ought to have died earlier" (even if you say it's for their own benefit) does nothing if you can't identify the actual points in the process of their aging and medical care where different decisions should have been made.

You need to identify those crucial decision points, and propose alternative protocols that do not cause inhumane pain and suffering to the person dying, and that take into account the effects on medical staff who have to implement them. It's not as simple as having a hard think about longevity and deciding to accept a bit less, and then job done, fewer people will need treatment, aging society sorted.

Lets look at Orthopeadics though. You have many, many tens (hundreds?) of thousands of 80/85/90/95 (100 year old Captain Tom), who still get treatment for hip and knee replacements. You can't withhold treatment on age alone. Quality of life, even if that life has dementia, or may be only another 6 months, is still important. You can't leave a person in pain regardless. So, some things will still always have to be done. MIL is 86 and needs a hip operation, she can't sleep lying down, she can't walk, she takes several very strong painkillers a day, so she is on a waiting list.

DM was in line for cataract surgery, aged 92. This because she could no longer read, something that is pretty important to a house-bound person. Age will not come into this equation, but quality of life will. On the other hand, she had a no-resus order, and no aggressive saving of life. She had a couple of heart attacks, but refused a stent, and when paramedics came, she refused to be taken into hospital. That doesn't mean she didn't get anti-biotics for a UTI though. She wasn't taken into hospital when she caught Covid, and she died. That was her choice though, and thank goodness she had it written down. This is much more important, let people make considered decisions. Preserve quality, but not necessarily quantity.

It will level out. My generation 30s will have a reduced life expectancy as we will have to work until we die! 👍🏼

meant to be a 😆

My father had a degenerative disease that rendered him locked in at the end, locked in to a body that was capable of living for a number of years with medical intervention. He knew that this would be the case and was clear that he did not want this to happen.
When he chose to stop eating and drinking it was very difficult for the care home and medical staff to accept our instructions not to intervene. He had been explicit in his wishes but the default for a man in his 60s was to ‘keep him alive’ . It was very difficult to watch the pain he endured towards the end and he was denied a dignified death as a result. I did not want to lose my dad but the dad I knew had long gone.
I think that my experience has perhaps clouded my views, but it has resulted in DH and I being very clear about our wishes.
Not everyone has a long happy life and dies with dignity and compassion. But it is important to discuss these things so that your nearest and dearest don’t drag out your life for their own benefit.
I remember having a very sobering chat with my DH’s 96 yr old GM. I commented on how great it must be to have lived a long fulfilling life. Her response was that it was ok but very lonely watching all the people you were close to falling by the way. At 96 most of the people she socialised with were 20yrs younger than her and of a different generation. She had lost 2 of her own children and all her siblings before she hit 80. She was still driving at 90 and spent all her time in her garden, once those pleasures were taken from her she faded fast.
The majority of care home residents are not living a happy life, but modern medicine is fantastic at keeping them hanging on.

I think there are lots of things that could almost certainly be improved when it comes to helping people make advance decisions and being informed about options, but that's solving a problem of quality of life . It's important to separate that from the question the OP raises which is more about economics and the healthcare system, the structure and the workforce and so on - a different problem. I doubt solving the quality of life problem will coincidentally fix the economic/structural issues caused by changing demographics.

@DuchessofHastings1

My thoughts exactly.

"Save the NHS" " No life is more important than the other" "protect the elderly"

Every year 10s of thousands of elderly die each year from the flu. If we had done lockdowns every year it would save millions of lives and relieve pressure on the NHS. But why haven't we? Quite simply cos cutting off the freedom of the majority to save a small percentage of the population is mad and not viable. Theyve been sacrifical lambs every year but Covid.....oh no...we must cut the country off and people have their conscience back

We didn't 'save the NHS out of kindness but self preservation. It was nothing to with conscience.

Nothing wrong with with allowing Euthanasia and I think it's an act of cruelty to say you will prevent someone dying against their will when they are suffering.

However any movement to cull the elderly poor for convenience is not going to fly.

We do need to do some serious planning. We can't stumble from one crisis to the next. 'Experts' say that the only way the economy can work is to have a rapidly expanding population with younger people supporting fewer older people. That can't go on in reality when the world has limited resources so we have to look at a new way of doing things anyway.

Google "first generation to die before their parents uk" and you'll find lots of newspaper articles suggesting that the problem will go away because the young are choosing to live such unhealthy lives. The "boomers" who are seen as having it so good grew up post war when hardly anyone had little luxuries like televisions and cars, few people owned their own homes, not many went abroad on holiday. They were expected to pay to support the elderly. Add to that increases in pension age so many of the "elderly" you are talking about are still in work, or would wish to be.

Now we have young people who have grown up having it all and quite a few on mumsnet dont wish to give anything back.

How many of you have an advance directive - or is this just another I want it all and other people to pay for me.

the young are choosing to live such unhealthy lives

choosing is a loaded word to chose!

The "boomers" who are seen as having it so good

It's a statistical fact not an opinion!

Now we have young people who have grown up having it all and quite a few on mumsnet dont wish to give anything back.

Well if there were true (it's not) I would blame the parents 🤷‍♀️

Justify your "statistical fact" over a lifetime. I was pointing out that many actually had poor childhoods, struggled with housing and will be working till they drop, sometimes to fund the university fees and house deposits of their offspring. They may also be trying to care for their own elderly parents.

And blaming the parents is typical of a spoilt generation.

I am strongly opposed to euthanasia but I can see why people support it - I just think it is too open to abuse and since the pandemic began I have read many things on here that have confirmed my view, simply because many people seem to have a completely un-nuanced view of old people’s value/quality of life. No, nobody should be kept alive with no quality of life and people’s wishes about DNR or living wills should be respected - life should not be preserved at all costs but the way some people talk about it, it sounds like the thin end of the wedge.

As for old people’s deaths being ‘tragic’ I do think it is very sad when people have died alone because of the pandemic when otherwise they would have had family with them. That must be very hard for the family and perhaps makes them perceive the loss as greater, despite the person’s age.

Justify your "statistical fact" over a lifetime

Why don't you justify some of your claims?

I was pointing out that many actually had poor childhoods, struggled with housing and will be working till they drop, sometimes to fund the university fees and house deposits of their offspring. They may also be trying to care for their own elderly parents.

Of course, who wouldn't expect some to have experienced that?

or is this just another I want it all and other people to pay for me.

You sound very bitter....

@LastTrainEast I know that, I was being sarcastic to the do gooders who think we should continue to put our lives on hold for a small percentage of the population.
Self preservation is the exact reason why this shit show shouldn't go on after May.

iveturnedintoachip - actually you sound very jealous, I'm pointing out you are exaggerating.

Do you have an advance directive - guess not.