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Posts Tagged ‘old people’

It was late July 2003 in the city of Auxerre in Burgundy. Authorities had been warning of very high temperatures for August, exceeding 40ºC during the day and no less than 20ºC at night.

M. Collardelle is in his early seventies. He is a healthy person with no more ailments than the usual for his age. He lives downtown, not far from the river, in a two storey-house with a nice small garden around it. With that setting, M. Collardelle does not worry about temperatures; he knows that the river and the garden will make life a lot more pleasant for him than for those who live in apartment houses on the outskirts of the city.

He had just received a telephone call from his only child who is vacationing in Spain with her husband and kids. They had a nice conversation and, to reassure his daughter, he reminded her that he had fought in the Algerian War, where he had endured much more than those forecasted 40ºC. They said goodbye, with M Collardelle telling his daughter not to call again. They would be back in France on the 15th.

So, the first of August arrived and with it, the dreaded 40ºC. And the second was the same and so forth and so on; and M. Collardelle realized that he was not in his twenties but some 45 years older, and he could not cope with the heat. He just sat in his armchair, with the windows open in hope of some respite, but what came from outside was more heat. He didn’t even have the energy to go to the kitchen to fetch a glass of water.

The 15th of August his daughter rang the bell, and as there was no answer, she opened the door and found her lifeless father in his beloved armchair. M. Collardelle had joined the more than 70.000 people who died from the heat wave that summer. 70.000 dead that would never have occurred if proper measures had been in place.

Hazards become real risks when the flow of early-warning-surveillance-preparedness- reaction breaks down for some reason. In the case at hand, it is clear that the early-warning system in place was not enough and that the flow never started; no surveillance, preparedness, or reaction were put in place.

Since 2003 things have improved; the European Climate Adaptation Platform[i] is a good example of how much things have changed. Today most countries have Heat-Health Action Plans to ensure that something like that will never happen again. Nevertheless, most plans focus on the activities that institutions at national, regional, and local levels have to carry out in case of an emergency. The diffusion and communication with citizens is mostly one way, from the institution to the public, at most an open line for people to report back, but with no real engagement or tracing whatsoever.

A comprehensive system for preventing a hazard from becoming a real problem is lacking. To start with, most plans are limited to a specific hazard or to a particular respondent. Very rarely is there a comprehensive focus on a situation that, in many cases, involves the occurrence of various simultaneous hazards.

It is also symptomatic that crisis management is only put in place once the crisis has reached a certain level. Those moments, from the occurrence of the event till the recognition by the relevant authorities that the event is in place, are mostly wasted. In fact, there is a lack of co-responsibility on the part of the citizenry in the response to an event.


[i] http://climate-adapt.eea.europa.eu/about accessed 12.07.21

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Have a look at those two demographic pyramids:

From 1950 to 2019 there has been a clear change in the European demographic structure. Low birth rates combined with higher life expectancy have transformed a pyramid into a barrel. Why we keep calling it “pyramid” is beyond my comprehension.

Enough has been said about the challenges and pressure put on the fiscal structure due to the demographic evolution.

The other side of the coin is the many possibilities opened by the natural ageing of the baby-boomer generation that made up the base of the pyramid of the 1950s. That generation, today in their 50s and older, is probably the generation with the best education and   economic resources  to “come of age” in the last 100 years. It is made up of the sons and daughters of the welfare state, with compulsory schooling and guaranteed pensions.

In the past month, two papers worth reading have come to my attention. One is focused on the United States, “The Longevity Economic Outlook”. The second focuses on Spain, “Los senior en España”.

The common denominator of both papers is how important for the economy and society it is to integrate and profit from the vitality of the 50 plus generations. As an example, that section of the population contributes 40% to the GDP of the United States and represents 44% of the work force.

As for Spain, where 39% of the population is 51 years old and older (see INE), the most striking feature, in contrast with tradition, is their answer in the survey about plans for their heirs. Over 60% responds that their children’s inheritance is their education. Add to that an average income of 1,500€ per month for almost 80% of them and you will get a generation with a propensity to consume well above the level of previous generations.

In short, once the pandemic is over, society has to make room for a generation of old people that does not feel old and that is ready to consume and be an active part of society for much longer than their forefathers.

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As the demographic pyramid evolves towards a demographic cylinder, we look to ICT as the solution. Even with the push that COVID-19 has meant for the use of ICT, I still doubt that ICT alone is the solution.

If we take ordering goods or services over internet for private use[i] as a proxy of the confidence of users in ICT, we can appreciate that even if between 2015 and 2020 there was an increase of ten points, from 62% to 72%, of internet users in EU27, there are still countries like Italy or Romania and Bulgaria with less than 50% of the population using internet for shopping.

Internet access follows a clear north-south divide[ii]: the population in northern countries who have never used internet is below 10%, while in southern countries, like Portugal or Romania, that percentage is above 20%, or even 30% in countries like Italy or Bulgaria.

Focusing on our target population: old people and informal carers, made up of mostly old carers and immigrants, only 32% of individuals over 64 have shopped online[iii]. Unfortunately, the same divide north-south happens with old people: while in places like Portugal, Greece and Romania less that 10% of old people have shopped online in the past 12 months, in countries like Belgium, Germany or Norway the percentage is above 40 or even 50%.

Going back to the question, is ICT the solution for caring for old people? The answer is a definitive no. Even in countries with a high percentage of old people with ICT literacy, we must assume that the normal evolution of ageing will make most of those people reliant on informal carers who not necessarily have the same ICT skills.

ICT is here to stay and with time will take a bigger and bigger role in the care sector but, as of today and in the near future, we will have to rely on informal carers. People mostly coming from eastern and southern countries in Europe with a lot of heart and passion for their job but little or no ICT skills. The challenge is to develop ICT solutions for these people. These solutions should be similar to WhatsApp, which is so successful because it is easy to use, and the rewards – communication with family and friends – are instant.


[i] Source Eurostat (online data code isoc_ec_ibuy)

[ii] Source Eurostat (online data code isoc_r_cux_i)

[iii] Source Eurostat (online data code isoc _ec_ib20)

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The idea comes from a podcast by The Economist, “The New Old”, in which Andrew Scott from the London Business School discusses the importance of acting rather than reacting.

The point is that there are millions of ideas developed for old people. Few have moved from the drawing board into everyday life. This lack of adoption of new ideas seems to stem from the fact that it is too late for old people to adapt to new inventions and/or methods. And also, it is too late once morbidity has already developed.

As the title clearly expresses, what we should aim for is helping people to develop healthy habits that will make ageing a lot more bearable and enjoyable.

Prevention has traditionally been the black sheep of the socio-health sector. There is a lot of talk about it and very little action. Dare to type “self-help” in Google or in Amazon, and the number of entries is in the range of the thousands. But still, there is no action from the public socio-health system.

It is usually the case in organizations that they tend to put out fires, while forgetting the most vital step:  preventing the fire. Acknowledging that fact, it is no consolation to see that the socio-health sector acts in the same manner: attending those already sick and forgetting about preventing sickness.

So the trend continues, and what the formal public sector does not provide, falls into the hands of the private sector: filling the gap started years ago with the self-help books, and which today has moved from books to apps and ICT tools of all kinds.

Of course, I am not against the private sector coming to the rescue; on the contrary. What I would very much like is for the public socio-health sector to integrate into their system those apps and other prevention tools that would, in the long run, ameliorate pressure on the socio-health system. In short: to integrate the concept of helping people to age better.

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During the pandemic, care-homes have been rat-traps for old people. In Canada more than 80% of deaths attributed to Covid-19 have been in care-homes; in places like England or Germany, the ratio was almost 40%. In Spain, the ratio is 68.67% according to estimates published by RTVE. I would say that something must be done.

I have written before about care-homes (see Services and conveniences) and the need for trained carers. But beyond that, what is needed is a complete overhaul of the way we care for old people. In most countries the system pivots on care-homes instead of caring at home.

Very few people argue that staying at home is the preferred choice of old people. It gives autonomy and independence, as well as familiar surroundings. Those characteristics are invaluable comforts as age advances. And not only that: according to a study, in Alabama those receiving care at home saved the State $4,500 a year, compared with those in care-homes.

As I see it, the only barrier to change the system is the system itself. Care at home implies a complete disruption of the care system logistics. It is easier to hire and control a care person in an institution. In the institution, the system can control comings and goings as well as productivity through close supervision. When you have people going from house to house, you have to give the person autonomy and trust that the work will be well done.

It is easy to see that the professional doing one institutionalized job, and the one doing the home care job have to have quite different training. They do basically the same work, namely helping with basic daily activities, so the difference is not in the acts to be performed. The basic difference is in trust, and trust comes with professionalism to be learned through proper training of attitudes more than aptitudes, even if the latter are also important. Unfortunately, I think the system is not ready for training real care professionals when it is relying on mostly immigrants, untrained and underpaid, who do the best they can with very little preparation.

Note: all the figures cited are taken from The Economist July 25th 2020 “The pandemic shows the urgency of reforming care for the elderly«

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When we talk about healthcare, even if nominally we are focusing on the patient, the reality is that we program the care process based on the capabilities and needs of the healthcare professional. If we didn’t do that, we still would have the family doctor coming home or, more realistically, Primary Care would be the prima donna of the healthcare process instead of the ugly duckling.

When we talk about social care, we rarely focus on the caregiver. We take for granted that the dear unmarried daughter will take care of her parents; is there anything better that she can do with her life? With that goes the assumption that the public purse does not need to divert its valuable resources to care for old people; there is always a family member willing to take care of the ageing person.

And this is the norm all over the world, and certainly all over the European Union.

In a previous post, “Beyond Covid-19”, in a back-of- the-envelope calculation, I estimated that Europe needs 23 million persons per year to work as caregivers. Let us assume that 10€ an hour is a reasonable medium wage in the EU, and we will get to a staggering 354,200 million € a year, roughly twice the annual budget of the EU.

I am not very optimistic about countries in the EU adding 2% of their GNP to their budgets. From now on, we will have to rely on imaginative approaches to care for our old people’s caregivers.

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I am taking the title from one of the chapters of the book New Ageing by Matthias Hollwich. The introduction to the chapter reads “At some point in our lives, things will get a bit harder and we will need help in one way or another. The best kind of help eases the way forward without replacing the capabilities we still have”.

It is this last sentence that has been haunting me for years. And not only in reference to informal care but also with formal care, including institutional care. Many years ago, I directed a study for nursing homes all over Spain. Of the many months I was involved in the project one comment from the director of one of the nursing homes has been engraved in my head. He told me, and I quote, “We are a factory of dependent persons; put an independent person in a nursing home and, in less than six months, that person will become dependent”.

Add to that, the above average incidence in the mortality rate that Covid-19 has caused in nursing homes all over Europe, from Sweden to Spain, and you will get a much less  rosy picture of nursing homes as a recourse for old people’s care.

A recent paper by the European Commission, Informal care in Europe: Exploring Formalisation, Availability and Quality, states that “Informal care forms a cornerstone of all long-term care (LTC) systems in Europe and is often seen as a cost-effective way of preventing institutionalisation and enabling users to remain at home”.

What I see as a problem is that, because of their lack of proper training, informal caregivers, and more if they are family members,  tend to overpower the old person: “Don’t do that”; “I’ll get it for you”; “Be careful, you’ll fall”, etc.. So, we go back to the beginning: the problem is to help the old person “without replacing the[ir] capabilities.”

We need to train informal caregivers. Basically, we need somehow to care for informal caregivers, to train and support them, even provide financial support for them, as the EC maintains. But training should be the first objective, since a properly trained caregiver will know how to take care of the old person and, equally important, of him or herself.

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I can understand that what happens today is more pressing than what will happen tomorrow, but that does not mean that today is more important. I think we should start looking at tomorrow and start planning what we will need for a world beyond Covid-19.

As of today, one of the few things we know for sure is that SARS-CoV-2, which produces the Covid-19, infects more old people and mainly those with previous chronicity. That means that it is old people who need more care.

Care that, we have also learned, would be better given at home than in nursing homes. Gathering vulnerable people in close quarters has proved not to be the best solution if we want to avoid the spread of a communicable disease.

Only if we are capable of building an army of caregivers will we be able to give home care in the EU to that 19% of the population aged 65 and older.

With a total population of almost 513 million people, we will need to take care of 97 million old people (all figures from Eurostat). Just for the sake of discussion, let us assume that we need one hour per day of care per old person. With an estimated 1.540 productive yearly hours per person, we will need almost 23 million caregivers. The fact that many of those 23 million will be informal caregivers does not make the hours and the people less essential.

Who will take care of that army of caregivers? Who will be providing training, moral and physical support for them? Very little is done today in that domain and almost nothing if we focus on informal caregivers. I think we must start getting ready to tackle caregivers’ needs, formal and informal, so that we will be able to provide our old people with the best possible care by the healthiest and most motivated caregivers.

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I have been wondering what the connection between people, especially old people, and a resilient society could be.

What is more resilient than an old person? They have demonstrated their resilience through the years. An 80 or 90 year old European has gone through at least one war, if not several if he or she is from one of those unfortunate countries (the Balkans, Ukraine, …) which have suffered also their own national wars.

And yet, when devising processes for a resilient society, we do not look to those generations that have proved to be resilient. What have they done to survive in such an unwelcome surrounding?

My answer is simple: adaptation.

I had a teacher in high school who provided an easy explanation for the difference between democracy and dictatorship. Dictatorship is like a concrete wall; it withstands high winds but if the wind grows strong enough it collapses and disappears. Democracy is like a wall made up of a sheet of paper; it bents with the wind and, when the wind does not blow anymore, it falls back in place. That is adaptation.

Going back to how to design for old age or for resilient societies, I think we should look at the same characteristic: adaptation. We will survive if we can adapt ourselves and our society to a changing world, be it new technologies or climate change.

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