Time we grew up about ageing

We need to recognise that older people can be productive citizens while still caring for those who can't

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It is funny how young people start to feel "ancient" at the age of 30, 21 or even 19, while older people refuse to think of themselves as old at the age of 60, 70 or even 80. At both ends of life, and at all points in between, negative attitudes towards ageing prevail. There is not much point, however, in complaining that old people used to be more respected in olden times. They probably were, but there were fewer of them then.

What matters is to try to create a modern idea of later life that gets the balance right between recognising that older people can continue to be productive citizens for much longer than the old retirement age, and looking after a large minority of old people who will need intensive social and medical care for a long period at the end of their lives.

Economic necessity has forced changes to the state retirement age and to pensions law, including this year's liberalisation of annuities, which have eroded the old cliff edge between the economically active and inactive, allowing many people to continue to earn in later life. However, there are still problems with the design of pension credit, which acts as a disincentive to continuing to work for too many. This is a neglected part of welfare reform, and it would be well worth Iain Duncan Smith, or his successor at Work and Pensions, devoting some time to it.

On the caring side, as we report today, the medical profession is not well oriented towards the care of older people. Although two out of three acute hospital admissions are of people aged over 65, according to research for the Royal Geriatrics Society, most medical training is focused on the maintenance of the younger, more resilient model.

"Most medical-school curriculums evolved in the last century, when the type of medicine that we practised was very different," says Dr Adam Gordon, a consultant and lecturer at the Nottingham University Hospital. Subjects as various as dementia, pressure sores and end-of-life care are not given the time on undergraduate courses that would reflect the proportion of doctors' working time that they now take up.

This is, in truth, only a small part of a bigger problem. Public policy has not yet come to terms with the growth of the elderly population, and the advances in science which mean that so many deaths will be medically managed.

For some time now politicians, operating on an electoral timetable that works against the solution of long-term questions, have shrunk from securing cross-party agreement on social care. We need to have some kind of social insurance system, underwritten by the Government, to protect us from the high costs of being among the one in five of us who will need long-term care before we die. One of the most depressing features of the last election campaign was the cynical labelling by the Conservatives of Andy Burnham's sensible proposals as health secretary as a "death tax".

It is fair to say, however, that attitudes towards death itself have matured considerably in recent decades. It is a sign of our greater willingness to talk about what was once the great unmentionable that the House of Lords is currently debating a change in the law to allow assisted dying. We welcome Lord Carey's change of mind on this subject, not least because we welcome any public figure, of any age (Lord Carey is 78), who has the humility to reconsider their view and to explain why. That said, we have reservations about Lord Falconer's proposed law, in part for the reasons so eloquently set out by Christopher Jones, who died of liver cancer in 2012.

However, the Lords debate this week is an important chance to raise awareness of these difficult end-of-life questions. Let us hope that this becomes part of a wider shift in people's attitudes towards ageing.

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