Catherine Conlon: How are the costs of an ageing population going to be met?
Despite billions of euros expected in windfall tax receipts over the next three years, Government predictions are that this will not be enough to cover the costs of an ageing population. Picture: iStock
Despite billions of euros expected in windfall tax receipts over the next three years, Government predictions are that this will not be enough to cover the costs of an ageing population, with PRSI increases needed to bridge the gap, ministers were told this week.
Some €65bn in budget surpluses are anticipated between now and 2026, much of it ‘windfall’ corporate tax receipts.Â
Finance Minister Michael McGrath is expected to bring forward legislation in the coming weeks to establish a long-term savings vehicle, similar to sovereign wealth funds in countries such as Norway, Australia and Japan.Â
However, such a fund is predicted to be insufficient to meet the entire cost of demographic change, which is estimated to cost an additional €7bn-€8bn a year by the end of the decade and to continue to climb thereafter.
New ESRI research, funded by the HSE, provides projections of public acute hospital workforce requirements both nationally and regionally in Ireland up to 2035.
The population is expected to increase to 5.4m and the number of people aged 85 years and older is projected to more than double.
To meet the needs of a burgeoning older population, the report states that medical staff will need to increase by between 1,802 and 3,236 whole time equivalents (WTEs) nationally.Â
Nursing and midwifery staff will need to increase by between 5,726 and 8,868 WTEs. Health and social care assistants will need to increase by between 1,802 and 3,277 nationally.
The acute hospital sector is already challenged to meet current healthcare staffing needs. How are the combined challenges of funding the costs of an ageing population and recruiting and retaining healthcare staff going to be addressed?
Could a focus on the biological age of this older population compared to actual chronological age be the missing link?
Professor Rose Anne Kenny, head of the academic department of Medical Gerontology at Trinity College Dublin, explains the separation of biological age from chronological age in her book .
"We are born with a fixed number of genes — our DNA — but some of our genes can be switched on or off by factors such as diet, exercise and psychological approach and attitude."
This switching on and off of genes is called epigenetics and these changes in gene function speed up or slow down ageing. Cells are more vulnerable or better protected from damage depending which genes are switched on or off.
Factors that affect our epigenetic clocks or pace of ageing include smoking, obesity, and stress — events that all cause our biological clock to speed up.
Another key factor is mood. Persistent stress, depression and anxiety can cause long-term damage from over exposure to the impact of stress hormones on our physiology.
Our perception of ageing also matters. Professor Kenny says a number of studies from her research group in Trinity College and others have confirmed that "we are as young as we feel", independent of disease status. This is because a positive attitude to ageing changes cell chemicals, possibly by reducing inflammation within the cell and influence the methylation status and epigenetics of the cell.
Every cell has a nucleus that gives instructions for all the cell’s activities. The nucleus houses our chromosomes, which hold our genes, and therefore our DNA that is responsible for cell division throughout life.
The chromosomes are capped by a telomere which is often compared to the plastic tip on the end of a shoelace that protects the chromosomes. The length of the telomere is used to determine the age of the cell.
Ageing is associated with damage to chromosomes which disrupts transfer of vital information from the nucleus to the rest of the cell. Flawed information on cell replication, production of energy and removal of waste materials impairs functioning and ultimately leads to the death of the cell.
Many age-related diseases, including arthritis, heart disease, cancer and dementia, occur because of an inability to clear waste products fast enough through cells.
Professor Kenny says interventions like food, exercise, friendship, laughter and sleep all have their effects at cell level, including on the ability to clear waste products fast enough through cells, management of unstable free radicals, and inflammation because of a malfunctioning immunity — that are all part of the theory of cell-ageing.
A recent study found that just 20 minutes of daily activity can reverse frailty in people aged over 65, according to research by University College Dublin.
The study — published in — shows how a combination of simple strength exercises and a protein-rich diet including milk, eggs, tuna, chicken, or plant-based protein such as beans and lentils, could help stop frailty and enhance physical resilience in those aged over 65.
The research identified significant improvements in the intervention group compared with the control group, including significant reversal of frailty, better grip strength, increased bone mass, and improved activity levels.
In terms of biological age, the study found the average age in the control group was three months older at the end of the three-month period, while the average age in the intervention group was seven months younger.
Beyond its essential role in providing nutrients, food can be a powerful tool in the prevention and treatment of disease. In a recent editorial in , the impact of dietary interventions on the potential to treat a wide variety of chronic disease and conditions is explored. The research generated strong evidence but developing a framework for integration of a healthy diet into health systems is critical if diet is to have an impact on healthy ageing.
In 2022, the Biden-Harris administration announced initiatives aimed at addressing access to and affordability of healthy food, as well as programmes to support better integration of nutrition and health to empower consumers to make healthy choices. A total of $8bn (€7.3bn) in public and private sector commitments have been pledged.
In Ireland, 70% of people over 50 are overweight or obese. With the UK, we are top of the obesity league in comparison to other European jurisdictions. The big issue with this is that obesity comes with accelerated ageing and early presentations of disease — sometimes by as much as 20 years early — such as heart disease, high blood pressure, arthritis, and liver disease.Â
Government policy that focuses on access to and affordability of healthy food has the potential to address healthy weight, frailty, and chronic disease as well as healthcare needs in older people over the next decade.
"Age is not a number: our biological changes are what counts, and the good news is that most of the factors that change our clocks are within our control to modify and improve — we control 80% of our ageing biology," Prof Kenny concluded.
Good healthcare is essential. Additionally, a focus on lowering biological age has the dual benefit of lowering costs to the national purse as well as improving health, wellbeing and resilience in an ageing population.
- Dr Catherine Conlon is a public health doctor in Cork and former director of human health and nutrition at Safefood
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