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Alan Walker Professor of Social Policy and Social Gerontology University of Sheffield, UK and Carol Walker Professor of Social Policy University of Lincoln, UK European Association of Service Providers for Persons with Disabilities (EASPD) Conference on Ageing and Disability, Graz, 8-9 June, 2006 Ageing and Disability: A Quality of Life Perspective

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Page 1: Alan Walker Professor of Social Policy and Social Gerontology University of Sheffield, UK and Carol Walker Professor of Social Policy University of Lincoln,

Alan WalkerProfessor of Social Policy and Social Gerontology

University of Sheffield, UK

and

Carol WalkerProfessor of Social PolicyUniversity of Lincoln, UK

European Association of Service Providers for Persons with Disabilities (EASPD) Conference on Ageing and Disability,

Graz, 8-9 June, 2006

Ageing and Disability: A Quality of Life Perspective

Page 2: Alan Walker Professor of Social Policy and Social Gerontology University of Sheffield, UK and Carol Walker Professor of Social Policy University of Lincoln,

• Ageing and Disability in Europe

• Gerontological Evidence on Quality of Life

• Policy Priorities for Quality of Life

ROAD MAP

Alan Walker, EASPD Conference on Ageing and Disability, Graz, 8-9 June 2006

Ageing and Disability: A Quality of Life Perspective

Page 3: Alan Walker Professor of Social Policy and Social Gerontology University of Sheffield, UK and Carol Walker Professor of Social Policy University of Lincoln,

Ageing and Disability in Europe

Ageing and Disability: A Quality of Life Perspective

Alan Walker, EASPD Conference on Ageing and Disability, Graz, 8-9 June 2006

Page 4: Alan Walker Professor of Social Policy and Social Gerontology University of Sheffield, UK and Carol Walker Professor of Social Policy University of Lincoln,

Alan Walker, EASPD Conference on Ageing and Disability, Graz, 8-9 June 2006

Page 5: Alan Walker Professor of Social Policy and Social Gerontology University of Sheffield, UK and Carol Walker Professor of Social Policy University of Lincoln,

The Ageing of the European Population

Alan Walker, EASPD Conference on Ageing and Disability, Graz, 8-9 June 2006

Page 6: Alan Walker Professor of Social Policy and Social Gerontology University of Sheffield, UK and Carol Walker Professor of Social Policy University of Lincoln,

• Ageing means more spending on health, social care and pensions

• A simple correlation between ageing and disability: ageing means more disability

The Negative Myths About Ageing Societies

Ageing and Disability: A Quality of Life Perspective

Alan Walker, EASPD Conference on Ageing and Disability, Graz, 8-9 June 2006

Page 7: Alan Walker Professor of Social Policy and Social Gerontology University of Sheffield, UK and Carol Walker Professor of Social Policy University of Lincoln,

• Current prevalence rates

• Projections

• The compression of morbidity

Ageing and Disability

Ageing and Disability: A Quality of Life Perspective

Alan Walker, EASPD Conference on Ageing and Disability, Graz, 8-9 June 2006

Page 8: Alan Walker Professor of Social Policy and Social Gerontology University of Sheffield, UK and Carol Walker Professor of Social Policy University of Lincoln,

0

10

20

30

40

16-24 25-34 35-44 45-45 55-64 65-74 75-84 85+

Age

% s

ever

ely

ham

pere

d

Age and Functional Limitation - EU 15 1998

Alan Walker, EASPD Conference on Ageing and Disability, Graz, 8-9 June 2006

Page 9: Alan Walker Professor of Social Policy and Social Gerontology University of Sheffield, UK and Carol Walker Professor of Social Policy University of Lincoln,

Disability rates for EU 15 (1999)

Ageing and Disability

Proportion reporting a physical,

sensory or mental disability 23%

Of whom: reporting severe disability 8%

Proportion 75+ reporting a physical,

sensory or mental disability 45%

Of whom: reporting severe disability 27%

Alan Walker, EASPD Conference on Ageing and Disability, Graz, 8-9 June 2006

Page 10: Alan Walker Professor of Social Policy and Social Gerontology University of Sheffield, UK and Carol Walker Professor of Social Policy University of Lincoln,

6062646668707274767880

1968 1971 1974 1977 1980 1983 1986 1989 1992 1995

Years

Exp

ecte

d ye

ars

USA

Japan

Australia

France

Canada

Life expectancy

Severe disability-free life expectancy REVES 1998

Severe disability-free life expectancy, males at birth

Alan Walker, EASPD Conference on Ageing and Disability, Graz, 8-9 June 2006

Page 11: Alan Walker Professor of Social Policy and Social Gerontology University of Sheffield, UK and Carol Walker Professor of Social Policy University of Lincoln,

Alan Walker, EASPD Conference on Ageing and Disability, Graz, 8-9 June 2006

Page 12: Alan Walker Professor of Social Policy and Social Gerontology University of Sheffield, UK and Carol Walker Professor of Social Policy University of Lincoln,

Dependency Projections 2000-2050

Growth in Numbers of Older People with Dependency Germany Italy Spain UK

1. Constant dependency rates 121% 107% 102% 87%

2. 1 year rise in life expectancy delays dependency by 0.5 years

73% 41% 79% 61%

3. 1 year rise in life expectancy delays dependency by 1 year

34% -1% 56% 35%

Alan Walker, EASPD Conference on Ageing and Disability, Graz, 8-9 June 2006

Page 13: Alan Walker Professor of Social Policy and Social Gerontology University of Sheffield, UK and Carol Walker Professor of Social Policy University of Lincoln,

• Absence of standardised data

• 2.3% of the population of the EU 15Range: 1.9% France, Sweden - 3.4% Spain

• Projections 1995-2020: 60+ 77% increase<15 62% increase

Ageing with an Intellectual Disability

Alan Walker, EASPD Conference on Ageing and Disability, Graz, 8-9 June 2006

Page 14: Alan Walker Professor of Social Policy and Social Gerontology University of Sheffield, UK and Carol Walker Professor of Social Policy University of Lincoln,

Gerontological Evidence on Quality of Life

Ageing and Disability: A Quality of Life Perspective

Professional vs. Lay Concepts

Alan Walker, EASPD Conference on Ageing and Disability, Graz, 8-9 June 2006

Page 15: Alan Walker Professor of Social Policy and Social Gerontology University of Sheffield, UK and Carol Walker Professor of Social Policy University of Lincoln,

Household Composition

Education

Labour Force Participation

Household Income and Financial Resources

Living Standards and Ability to Participate

Health Status

Family Life

Community Life and Social Participation

Other Domains eg. housing tenure, life satisfaction

Fahey, Nolan and Whelan, 2002

Alan Walker, EASPD Conference on Ageing and Disability, Graz, 8-9 June 2006

Core Life Domains

Page 16: Alan Walker Professor of Social Policy and Social Gerontology University of Sheffield, UK and Carol Walker Professor of Social Policy University of Lincoln,

http://www.shef.ac.uk/uni/projects/gop/

Evidence from the UK Growing Older Programme

Alan Walker, EASPD Conference on Ageing and Disability, Graz, 8-9 June 2006

Page 17: Alan Walker Professor of Social Policy and Social Gerontology University of Sheffield, UK and Carol Walker Professor of Social Policy University of Lincoln,

having good social relationships with family, friends and neighbours;

having social roles and participating in social and voluntary activities, plus other activities/hobbies performed alone;

having good health and functional ability; living in a good home and neighbourhood; having a positive outlook and psychological well-being; having adequate income; maintaining independence and control over one's life.

Source: Bowling et al (2002)

Alan Walker, Current Research in Gerontology and Social Policy, Hong Kong Baptist Alan Walker, Current Research in Gerontology and Social Policy, Hong Kong Baptist University, 26 April 2006University, 26 April 2006

The Foundation of a Good QoL in Old Age

Alan Walker, EASPD Conference on Ageing and Disability, Graz, 8-9 June 2006

Page 18: Alan Walker Professor of Social Policy and Social Gerontology University of Sheffield, UK and Carol Walker Professor of Social Policy University of Lincoln,

Maintaining health and independence, social activities

and relationships, Neighbourly and safe areas, Local amenities and services, Participation, Transport, Finance.

Source: Bowling et al (2002)

Maximising Quality of Life

Alan Walker, EASPD Conference on Ageing and Disability, Graz, 8-9 June 2006

Page 19: Alan Walker Professor of Social Policy and Social Gerontology University of Sheffield, UK and Carol Walker Professor of Social Policy University of Lincoln,

The Magnificent Seven

Alan Walker, EASPD Conference on Ageing and Disability, Graz, 8-9 June 2006

Page 20: Alan Walker Professor of Social Policy and Social Gerontology University of Sheffield, UK and Carol Walker Professor of Social Policy University of Lincoln,

• Employment

• Maintenance of Health and Autonomy

• Care and Carers

• Social Inclusion/Participation

Policy Priorities for Quality of Life

Ageing and Disability: A Quality of Life Perspective

Alan Walker, EASPD Conference on Ageing and Disability, Graz, 8-9 June 2006

Page 21: Alan Walker Professor of Social Policy and Social Gerontology University of Sheffield, UK and Carol Walker Professor of Social Policy University of Lincoln,

Employment Ratio Among Disabled and Non-Disabled People

Alan Walker, EASPD Conference on Ageing and Disability, Graz, 8-9 June 2006

Page 22: Alan Walker Professor of Social Policy and Social Gerontology University of Sheffield, UK and Carol Walker Professor of Social Policy University of Lincoln,

Demographic Characteristics of Disabled and Non-disabled Working Age Population (%)

Disabled Non-disabled

Age (years)

16-24 6.4 17.0

25-34 12.6 25.5

35-44 17.7 23.6

45-54 24.9 19.0

55-64 38.4 14.9

Gender

Male 47.3 48.9

Female 52.7 51.1

Educational level

Low 52.7 42.7

Medium 34.5 39.2

High 12.8 18.1

Source: ECHP, 1996

Alan Walker, EASPD Conference on Ageing and Disability, Graz, 8-9 June 2006

Page 23: Alan Walker Professor of Social Policy and Social Gerontology University of Sheffield, UK and Carol Walker Professor of Social Policy University of Lincoln,

• Cardiovascular Diseases (eg. coronary heart disease)

• Hypertension

• Stroke

• Diabetes

• Cancer

• Chronic Obstructive Pulmonary Disease

• Musculosketal Conditions (eg. arthritis, osteoporosis)

• Mental Health Disorders (eg. depression, dementia)

• Sensory Impairment

The Contexts of Care’ The Places of Care: History and Outlook from XV to XXI Century, Turin, June 18-20th, 2004

Source: WHO (1998)

Major Chronic Conditions Affecting Older People

Alan Walker, EASPD Conference on Ageing and Disability, Graz, 8-9 June 2006

Page 24: Alan Walker Professor of Social Policy and Social Gerontology University of Sheffield, UK and Carol Walker Professor of Social Policy University of Lincoln,

Development of NCD

Age

ES: socioeconomic status PA: Physical activity Source: Aboderin et al., 2002, p.17

Fetal life

SES;maternalnutritionalstatus;birthweight

Infancy andchildhood

SESdiseasesgrowth rate

Adolescence

Obesitylack of PAsmokng

Adult life

Established adult

Behavioural/biologicalrisk factors

high

Accumulate

d

risk

(range)

low

Scope of non-communicable diseases prevention: a life course approach

Alan Walker, EASPD Conference on Ageing and Disability, Graz, 8-9 June 2006

Page 25: Alan Walker Professor of Social Policy and Social Gerontology University of Sheffield, UK and Carol Walker Professor of Social Policy University of Lincoln,

Proportion of Disease Burden (DALY) Attributable to Risk Factors (all ages)

EU 25

Smoking 9.0

Alcohol use 8.4

Vegetable/fruit deficiency in diet 3.5

Overweight 3.7

Fat content of food 1.1

Physical inactivity 4.4

Relative poverty 3.1

Work environment 3.6

Alan Walker, EASPD Conference on Ageing and Disability, Graz, 8-9 June 2006

Page 26: Alan Walker Professor of Social Policy and Social Gerontology University of Sheffield, UK and Carol Walker Professor of Social Policy University of Lincoln,

Unfortunately and incorrectly people with potentially disabling conditions often are not recognised as a target population for primary prevention effort, despite the fact that having a potentially disabling condition frequently increases the need for good health promotion and disease prevention practices.

The Contexts of Care’ The Places of Care: History and Outlook from XV to XXI Century, Turin, June 18-20th, 2004

Pope and Tarlov, 1991, p.105.

Alan Walker, EASPD Conference on Ageing and Disability, Graz, 8-9 June 2006

Page 27: Alan Walker Professor of Social Policy and Social Gerontology University of Sheffield, UK and Carol Walker Professor of Social Policy University of Lincoln,

Prevalence of Care Dependency in EU

Alan Walker, EASPD Conference on Ageing and Disability, Graz, 8-9 June 2006

Page 28: Alan Walker Professor of Social Policy and Social Gerontology University of Sheffield, UK and Carol Walker Professor of Social Policy University of Lincoln,

Projected Increase in Numbers of Older People Receiving Formal and Informal Care 2000-2050

Germany Spain Italy UK

Numbers receiving informal care 119% 100% 109% 72%

Numbers receiving home-based care 119% 99% 119% 92%

Numbers receiving institutional care 127% 120% 81% 102%

Growth in expenditure 120% 115% 96% 102%

Expenditure as % GDP in 2050 2.72 1.39 1.94 2.75

Alan Walker, EASPD Conference on Ageing and Disability, Graz, 8-9 June 2006

Page 29: Alan Walker Professor of Social Policy and Social Gerontology University of Sheffield, UK and Carol Walker Professor of Social Policy University of Lincoln,

Age Distribution of Carers in the EU 25, 2005 and 2030 (%)

2000 2030

Age

Carers providing

+20 hrs pw

Carers providing

+35 hrs pw

Carers providing

+20 hrs pw

Carers providing

+35 hrs pw

25-49 38 38 29 29

50-64 38 38 39 39

65+ 24 24 31 32

Alan Walker, EASPD Conference on Ageing and Disability, Graz, 8-9 June 2006

Page 30: Alan Walker Professor of Social Policy and Social Gerontology University of Sheffield, UK and Carol Walker Professor of Social Policy University of Lincoln,

0

5

10

15

20

25

30

35

40

Social Cultural Civic Services Nbrhood Financial Material

%

Excellent

Very good

Good

Fair

Poor

Exclusion by self-assessed general physical health

Alan Walker, EASPD Conference on Ageing and Disability, Graz, 8-9 June 2006

Page 31: Alan Walker Professor of Social Policy and Social Gerontology University of Sheffield, UK and Carol Walker Professor of Social Policy University of Lincoln,

0

5

10

15

20

25

Social Cultural Civic Services Nbrhood Financial Material

%

Not depressed

Depressed

Exclusion by depression status (CESD questionnaire)

Alan Walker, EASPD Conference on Ageing and Disability, Graz, 8-9 June 2006

Page 32: Alan Walker Professor of Social Policy and Social Gerontology University of Sheffield, UK and Carol Walker Professor of Social Policy University of Lincoln,

• Combating age/disability barriers to employment

• Active ageing: promotion of health and well-being across the life course

• National strategies for ageing carers

• Promoting social inclusion: national and local policies

Key Policy Directions:

Responding to the Policy Challenges

Alan Walker, EASPD Conference on Ageing and Disability, Graz, 8-9 June 2006

Page 33: Alan Walker Professor of Social Policy and Social Gerontology University of Sheffield, UK and Carol Walker Professor of Social Policy University of Lincoln,

• Combat ageist stereotypes (eg. age awareness training)• Base support on ability and potential not disability• Maintain aspirations and expectations regardless of age• Retain the goals of inclusion, participation and choice• Initiate health promotion: it is never too late• Treat disabled people and their family carers as equal partners in

planning their lives• Provide a single point of contact with advice on services and social

protection• Instill a service philosophy based on consistent principles such as

social inclusion, empowerment and normalisation

Key Messages for Service Providers:

Ageing and Disability: A Quality of Life Perspective

Alan Walker, EASPD Conference on Ageing and Disability, Graz, 8-9 June 2006

Page 34: Alan Walker Professor of Social Policy and Social Gerontology University of Sheffield, UK and Carol Walker Professor of Social Policy University of Lincoln,

• Ageing and Disability in Europe

• Gerontological Evidence on Quality of Life

• Policy Priorities for Quality of Life

ROAD MAP

Ageing and Disability: A Quality of Life Perspective

• Conclusion

Alan Walker, EASPD Conference on Ageing and Disability, Graz, 8-9 June 2006

Page 35: Alan Walker Professor of Social Policy and Social Gerontology University of Sheffield, UK and Carol Walker Professor of Social Policy University of Lincoln,

THE END

THANK YOU

Ageing and Disability: A Quality of Life Perspective

Alan Walker, EASPD Conference on Ageing and Disability, Graz, 8-9 June 2006


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