CHAPTER 3: HEALTH

Health is a key determinant of quality of life and well-being for older people, impacting significantly on the extent to which they can enjoy life and participate in the economic, social and cultural life of their community. An ever-increasing body of gerontological knowledge and science, both Irish and international, can now shape our deliberations on health and ageing, and it is important that strategy and policy are informed by this evidence base as far as possible.

To plan adequately for the healthcare needs of older people in the future, calls for a recognition of the profound demographic changes occurring in Irish society now, and those likely to occur over the next decades. These changes will have an impact on the ability of the health system to respond to the needs of older people, as well as on the availability of care and carers. The key issues which will necessitate a new approach to planning for will be dealt with in greater detail below, they include:

• An increase in longevity largely as an outcome of improvements in health care, life-styles and diet, as well as other factors such as housing etc
• An increase in chronic health conditions – The numbers of people suffering from chronic conditions will increase as people survive illnesses which they would have previously died from. This will call for a shift in focus: to the management of chronic illness over longer periods. There is also potential to prevent, delay or mitigate chronic health conditions and to improve overall wellness through screening and pathways to early care as well as increased self-care and more care in the community.
• An increase in the number of people with disabilities as people who had disabilities earlier in life survive conditions which would have previously been fatal, and as people who acquire disability in later life also live longer.
• An increase in the need for specialist medical and care professionals with the necessary gerontological training.
• An increase in life-style related conditions such as obesity, diabetes and alcohol-related conditions.

These changes clearly call for new approach to the delivery of health services to ensure that the necessary level of care is given in the most efficient way and in the appropriate setting to meet the needs and preferences of older people as well as responding to the future budgetary and fiscal pressures.

This chapter will examine the factors and trends that will influence our ability to develop and deliver a quality health service to older people. It discusses the importance of planning for an ageing population and presents evidence on the prevalence of chronic conditions and the impact that demographic trends will have on healthcare service delivery. The chapter will also consider the evidence for conditions that can be prevented, deferred or modified. It will examine the effectiveness of interventions and the issues associated with determining cost effectiveness of such interventions. It discusses issues relating to the delivery of health services in the community but also in hospital and long-term care settings. It will also look at issues associated with poor management of prescribed medications and the role that assistive technology can play in reforming the health system.  It also addresses end-of-life and disability health issues.