Abstract
Extra longevity is not such a boon if it is accompanied by enhanced morbidity. Ageing leads to a greater incidence of neurodegenerative diseases, e.g. Alzheimer’s and Parkinson’s. Unlike its success with cancer and cardiovascular ills, medicine has been largely unsuccessful in dealing with dementia; research, diagnosis and treatment are all under-funded and unsatisfactory. The costs of such diseases are bound to grow rapidly, partly by diverting a growing proportion of the available workforce into care for the dependent old. Even then, the availability of properly trained carers will probably be insufficient, leading to a greater burden for the affected old and their families. Combine this with the rising age of having children and the result is a markedly changing life-cycle pattern, one that Goodhart and Pradhan argue will reduce the household savings ratio.
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Notes
- 1.
Thus Kingston et al. (2018a, p. 3) note that, ‘Over half (54.0%) of the population aged 65+ in 2015 have two or more diseases. As expected, multi-morbidity increases with age: in 2015, from 45.7% for those aged 65–74 to 68.7% for those aged 85+; and over time: to 64.4% in 2025 and 67.8% in 2035, for those aged 65+’.
- 2.
Of course, the dividing line between those with mild cognitive impairment, e.g. forgetting names, and with low dependency is fuzzy, but the Population Ageing and Care Simulation model (PACSim) for the UK, from which these data were taken, is state of the art.
- 3.
Also obesity is more common in women.
- 4.
Approach a sample of adults. Explain how the probability of dementia rises with age. Then ask what proportion of their annual income (from now until retirement) they would be prepared to pay to reduce the probability of becoming subject to dementia by 10% throughout, e.g. from, say, 40% at age 82 to 30% at that age, assuming that could be done with certainty. The results of this hypothetical test would be subjective and indicative only, but better than nothing. Also on this, see Kydland and Pretnar (2018, 2019).
- 5.
For example, on diagnosis, The Lancet Commissions, (2017, p. 2690), states,
A timely diagnosis, meaning communicating a diagnosis at a time when the person with dementia and their carers will benefit from interventions and support, is a prerequisite for good dementia care. Many people with dementia are never given the diagnosis, only 20–50% of those with dementia have a diagnosis recorded in primary care notes, and this number is lower in lower-income countries than high-income countries. Many receive a diagnosis when it is too late for them to make decisions about their own and their family’s future or to benefit from interventions.
- 6.
In his paper on ‘Fixing the Care Crisis’, Damian Green (ibid) would introduce a tax-funded new Universal Care Entitlement, ‘which guarantees everyone a decent standard of care’, to be supplemented by a privately purchasable ‘Care Supplement’. Also see Kydland and Pretnar (2018, 2019).
- 7.
World Alzheimer Report (2016, p. 6),
Dementia specialist care is underdeveloped in LMIC. There are very few geriatricians, neurologists and psychiatrists, and few hospital or community-based services dedicated to diagnosis and continuing care. Coverage of continuing care services remains low in HIC, in part because of low diagnostic coverage, but also because specialist services struggle to provide continuous and responsive care to rapidly increasing numbers of people with dementia.
- 8.
In Japan apparently more old people’s nappies are sold than for babies.
- 9.
Robots have an EQ of zero. While robots can play a limited role, see the Lex Column in the Financial Times, Monday, June 10 2019, p. 22, ‘Robots/ageing Japan: I, carebot’, the emphasis should be placed on the limitations of that role.
- 10.
In the Financial Times (Lex, Monday, June 10 2019, p. 22), it was stated that
Japan has the most rapidly ageing population in the world. Low birth rates have continued for three decades. Almost a third of the population is over 65. To help look after them, Japan needs to increase the number of care workers almost sevenfold over the next decade from the current 1.5 m. Paid carers would constitute more than a 10th of the workforce.
- 11.
In the Financial Times report on ‘Foreign operators take on Chinese elderly care’, July 16 2019, p. 14, it was stated that
About 90 per cent of Chinese seniors rely mainly on family support, 7 per cent on residential community-based care services and 3 per cent on nursing homes, according to the Qianzhan Industry Research Institute, a consultancy.
- 12.
The number of such child dependents per family has been falling, which reduces the time span of having dependent children by a few years. But offsetting this, the increase in take-up of higher education means that each child will probably stay at home with his/her parents for longer.
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Goodhart, C., Pradhan, M. (2020). Dependency, Dementia and the Coming Crisis of Caring. In: The Great Demographic Reversal. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-030-42657-6_4
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DOI: https://doi.org/10.1007/978-3-030-42657-6_4
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