EU – Perspective Barbro Westerholm, Prof., Vice President AGE Graz June 8, 2006

1. Living conditions as they are now for ageing peoplewith a disability and the livingconditions for all ageing persons EU – Perspective Barbro Westerholm, Prof., Vice President AGE Graz June 8, 2006

2. During the past century the average life expectancy of Europeans has increased by 28 years, from 45 to 73 years This is a victory!

3. Demographic changes 60+, 2000 - 2050 EU 22% - 40% Austria 20% - 40% Belgium 22% - 38% Denmark, Finland, Sweden, Luxemburg 20% - 36% France, Portugal 21% - 38% Germany 23% - 40% Great Britain 21% - 37% Greece 23% - 41% Ireland 16% - 39% Italy 24% - 44% The Netherlands 19% - 37% Spain 22% - 44%

4. Definition of ”older people” • 50 + ? • 60 + ? • 65 + ? Older people are individuals who differ from each other. The diversity should be acknowledged and leads to different needs Older people are young people who have lived for some time Chronological age is misleading!!!

5. Living conditions of older people in the EU, needs and desires • Access to • work/ adequate pensions • social networks • adequate housing • adequate nutrition • transport, communication, environments • education • cultural activities • health promotion • health care of high quality • palliative care • support to family carers

6. Needs and desires continued • Social integration, participation • Interest representation • Freedom from crime/violence/abuse

7. Definition of disability World Health Organization: A disability (resulting from an impairment) is a restricted ability to perform an activity in the manner or within the range considered normal for a human being

8. Disabilities in old age – how common? • EU statstics say that women can expect to live 66 years and men 63 years without any disability • Almost one in four elderly people describe their health as bad, women more often than men • Around six million Europeans are affected by dementia

9. Many of the added years are healthy years but… • Approximately 20% of people aged 70 years or older and 50% of people aged 85 and over, report difficulties in such basic activities of daily living as bathing, dressing, toileting, continence, feeding, and transferring from chair to bed. • Women report more difficulties than men

10. Causes of disabilities in old age • Congenital – anatomical, physiological or mental abnormalities • Diseases, especially multiple diseases • Injuries • Impairments – anatomical, physiological or mental abnormalities) • The disablement process is modified by factors related to life style, the availability and use of services, ageing processes and characteristics of the social and physical environment (Disability in old age, Burden of Disease Network Project 2004, BURDIS)

11. Disability: policies for people with special needs (1) • The EU approach to disability does not identify separate categories of people, it is instead based on individual needs. This is a much more socially-inclusive approach than one based on cagegorisation. It implies a general shift away from disability-specific programmes towards a manistream approach. • The goal is to ensure that people with disabilities enjoy the same human rights as everyone else, by removing barriers and combating all forms of disability-related discrimination. Source: The social situation in the European Union 2004, European Commission

12. Disability: policies for people with special needs (2) • Trends in EU-15 countries are generally positive in this area, although several obstacles remain, where much more effort is still needed – notably physical, legal and administrative barriers, new technologies and attitudes

13. Disability: policies for people with special needs (3) • Barriers: In many new Member States disability policies still tend to be oriented towards segregation rather than mainstreaming action across all policy areas. Moreover, although quota systems are prevalent, there appears to be major problems with their practical enforcement. Disability policies in these countries are only now beginning to move away from the old-style `protectionist`policies and medical models of disability

14. Disability: Policies for people with special needs (4) • Problems: The movement away from sheltered employment has, initially led to higher unemployment for people with disabilities: so far it has not yet been compensated for by the necessary supportive policies and mainstream employment opportunities for disabled people, who may not possess the education, experience or training to be employable in the open labour market.

15. Disability: policies for people with special needs (5) • Problem: In addition the focus on reasonable accommodations for disability in the Employment Equality Directive has not yet filtered through to policies and practices in new member states

16. Green paper on Mental Health 2005 • ”Promoting mental health in older people An ageing EU-population, with its associated mental health consequences, calls for effective action. Old age brings many stressors that may increase mental illhealth, such as decreasing functional capacity and social isolation. Late life-depression and age-related neuro-psychiatric conditions, such as dementia, will increase the burden of mental disorders. Support interventions have shown to improve mental well being in older populations”

17. Austria Belgium Finland France Germany Great Britain Greece Italy The Netherlands Portugal Spain Sweden Mapping existing research and identifying knowledge gaps concerning the situation of older women (and men) in Europe (MERI)www.own-europe.org

18. MERI Sorces – research and public statistics

19. Findings • General conclusions: Despite the fact that women live longer they more often suffer from disabling diseases and disabilities and therefore are more dependent on help than men. If they are disabled they more often live alone than men

20. MERI – some country findings (1) • Austria – Whereas older women aged 50 – 69 are less likely to suffer from hearing impairments than men of respective age group, the ratio changes considerable for the age groups 70 – 79 and 80+. Women 60+: the most commonly reported diseases are varicose veins, thrombosis, phlebitis, rheumatism, slipped discs and osteoporosis

21. MERI – some country findings (2) • Belgium: Serious health problems and the consequent disabilities, men are affected more frequently than women • Finland: Functional capacity of the elderly, both men and women, have improved markedly during the past 20 years. Persons with higher than basic education have fewer ability limitation than others. Disability pension applications submitted by women are rejected more ofthen than applications submitted by men.

22. MERI – some country findings (3) • France: Women are more prone to illnessess and disabilities and consequently to dependency. Paradoxically, they use fewer appliances and prostheses, etc. The explanation for this is that technical aids (glasses, hearing aids, crowns and dental implants etc) are often only barely covered (if at all) by health insurance.

23. MERI- some country findings (4) • Italy: The number of older disabled women is almost double than that of older disabled men (65+ 67.7% vs 39.5%). The psychological condition of disabled women is much more critical than that of men in the same situation. • The Netherlands: Differences in functional limitations and impairments (e.g. sight and hearing) are unfavouralble to older women and stresses the need for gender-specific registration and classification systems in health care.

24. MERI – some country findings (5) • Spain: The high prevalence of chronic diseases (arthritis, heart pathologies, cerbro-vascular accident and dementia) among older women with disabilities has a consequence the need for help care (daughters, spouses and other relatives) • Sweden: Many symptoms, disorders and disabilities are found to be more common in older women than men BUT the results of the research are not being used to the extent they deserve

25. MERI- some country findings (6) • United Kingdom: Physical disorders/disbilities was the area best covered in most studies, eg difficulty with eyesight, hearing, mobility, self care and domestic tasks. Mobility is described in terms whether a range of particular tasks cannot be undertanken at all, whether the person can usually manage the task with help, and the use of mobility ades.

26. Disability prevention, interventions and research.Recommendations by the BURDIS network (2004) • Trials aimed at prevention of disability in old age should be given priority • Standard criteria should be developed and validated for the identification of older persons at risk of disability from a life course perspective • Multi-component interventions need to be developed and tested • Research into the roles of environmental factors (social, physical, economic, cultural and political domains) should be strengthened

27. Development of health and social services(BURDIS Network 2004) • Comprehensive geriatric assessment • Preventive home visits • Health promotion • Screening for frail people in the community • Home care, • Management of chronic diseases • Medication !!! • Councelling • Adequate housing and pensions • Creating accessible environments • Preventing prejudice and diskrimination

28. What about the NGO:s • European level – does not pay special interest to older disabled persons • Sweden – umbrella organisation – has reacted against the fact that a Swedish parliamentary committee SENIOR 2005 has only briefly described the needs of older disabled people • Individual Swedish organisations who do pay interest: • NGO – mental handicap • NGO – polio patients • NGO – diabetes • NGO -- hearing

29. Key issues • Statistics and research on the living conditions for all ageing persons including the disabled have to be developed both on national and European level • Research on determinants of disabilities in old age has to be prioritized • Interventions for the prevention of old age disabilities have to be developed • The access to adequate housing, accessible environments, social networks, adequate pensions, gerontologic and geriatric competence, rehabilitation, screening, home care, optimal medication, adequate nutrition etc has to be improved • Freedom from abuse and discrimination

30. Final reflections • Our knowledge about the size and composition of older disabled people is incomplete – is mainstreaming one of the causes? • Policies for older people and disabled people should not be separated by walls, there are areas where they have much in common