Taking care of our elderly is a priority

by Paul Mulholland The Irish Geronto-logical Society re-cently held its Annual Scientific Meeting highlighting new developments in research into ageing in Ireland. President of the Society, Prof Des O’Neill hailed the range and quality of the research presented, which included a study on the use of antibiotics as therapy for Alzheimer’s disease, and new treatments for macular degeneration. It followed news from the World Stroke Congress in Vienna that the time-frame for the safe delivery of thrombolysis has been extended from three hours to four and a half hours. However, progress made in the medical treatment of age-related conditions has been hampered, according to many geriatricians and representative bodies, by the HSE’s failure to provide an adequate level of service and its delaying much needed reform. For instance, consultant neurologist in the Mater Hospital, Dublin, Prof Peter Kelly, told IMN that despite the possibility of treating more patients with thrombolysis, the study raises huge logistical issues given the deficiencies in Irish stroke services highlighted in the national audit on stroke services in April. For every positive development in old age care over the last year, such as the publication of HIQA’s national quality standards for residential care settings for older people, there have been corresponding negatives like the delay in implementing the nursing home support legislation, Fair Deal, and cuts in homecare packages. To improve standards in the area, the IMO and the British Medical Association in Northern Ireland have launched a joint policy document entitled, Care of Older People on the Island of Ireland. Amongst its proposals is a call for clear lines of communication between all agencies and workers in-volved in the care process, including acute and primary care, and all sectors to have round-the-clock access to details of an older person’s medication and clinical condition. The document states that for those living alone, domiciliary and other healthcare services should be appropriate, coordinated and of a high standard, with minimal bureaucracy. Also, older people should be asked what their needs are, services should include opportunities for social interaction and nutritional care should be made a priority, according to the document. Care for the elderly should be based on clinical need and appropriate care cuts down on unnecessary hospital stays, IMO President Dr Martin Daly told IMN. There is also evidence that the elderly are less likely to receive vital clot-busting drugs when they have a heart attack or stroke and they should have the same access as any other age group. Dr Daly criticised the reported plans of the HSE to cut the over-70s medical card, which was introduced in 2001, calling it a retrograde step. Age Action have also come out against the proposed plan which it says would fly in the face of the current push towards community care and the drive to keep older people out of hospitals and nursing homes. The over-70s medical cards have helped considerably to keep people out of hospitals, spokesperson for Age Action, Mr Eamon Timmins told IMN. It would also be very expensive to return to means testing people for the card. It has already been established that 89 per cent of people over 70 are entitled to the card anyway. Bringing in means testing would be a waste of money and resources, which would also bring delays in patients receiving cards. Another issue he points to is the discrepancy in home support across the country, which is affecting the provision of uniform community services. Mr Timmins said that 2008 was a tough year for older people, and it was likely that 2009 would be just as bad given the economic climate. Despite the predicted tough budget, he contends it is vital that measures are put in place to protect the health and wellbeing of older people this winter. We need urgently to increase the fuel allowance. Many older people we’ve been speaking to say they will cut down on food and fuel costs in the winter, he said. We would be very worried if this happens as they would be opening themselves up to the danger of respiratory illness and circulatory problems. Each winter in Ireland there are a lot of deaths as the result of cold-related illnesses and most of the victims are older people. Mr Timmins pointed out that there has been no increase to the living alone allowance, which Age Action is also calling for to be increased, since 1996. He also criticised the delay in putting through the Fair Deal legislation, the Bill for which was published last week. Although Age Action has issues with the scheme, which it says amounts to a selective inheritance tax on the elderly, Mr Timmins says the Government must clarify its plans to implement the legislation. The argument over problems we have with Fair Deal has been lost, Mr Timmins said. But we need to find out what is going to happen next. Many older people are in limbo at the moment as they have made their plans on the basis that the legislation would be introduced. His concerns with the legislation echo the opinion of Cork-based geriatrician, Prof Cillian Twomey. Geriatricians are not happy with the proposed legislation, Prof Twomey said. In effect it means patients are going to have to pay for themselves or pay retrospectively. It is an inequitable proposal. It is only fair in the sense of levelling the playing field for people paying for care but is not fair in terms of access to care. People in the acute service are not asked to pay for care, why is this the case with elderly patients? However, he told IMN that it would be unfair to say that there have been no improvements in health services to older people over the last decade, and welcomes the fact that every major hospital in the country has a geriatric service. Former IMO President and consultant geriatrician in Nenagh General Hospital, Dr Christine O’Malley, feels the health service is creating paper mountains of new strategies and proposals, and not concentrating on healthcare delivery. The new growth industry seems to be coming up with reports and strategies, Dr O’Malley said All the effort in developing them are having little effect in treating older people. Elderly wards are being closed, home care packages are being cut, and more people are on trolleys, who mainly consist of older people. She said that the closure of the elderly ward in June in her own hospital to bring the budget into line has devastated the service she can provide and says there are currently no plans to reopen it. “It is symptomatic of what is happening in the health service at the moment, she said. In the current climate, I can’t see things getting better in the short-term.