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BMJ No 7115 Volume 315 Medicine and books Saturday 25 October 1997
Ageing EuropeAlan Walker, Tony MaltbyOpen University Press, £14.99, pp 160
This book focuses on how social and economic policies affect older people, relying on data collected for the European Commission. The section on employment and older workers should interest doctors and policy makers, as many older patients will be struggling with the social and financial implications of no longer having a job. People are retiring earlier - either through choice or redundancy. Despite initiatives to secure older workers' access to work, many employers discriminate against them. And fewer guarantees exist than in the past to protect older employees as the industrial world reduces its workforce. While older workers are acknowledged as teachable, dependable, and reliable, they are finding it increasingly difficult to remain in work. Early retirement may have negative consequences, even when accompanied by adequate financial support. Many workers have lost control over when their retirement begins - employers more often decide now. Social rights and "entitlements" related to retirement have also been lost, undermining older workers' sense of security. Interestingly, the book quotes a Eurobarometer survey, which found that a substantial proportion of Europeans (including about 70% of British respondents) believe that governments should introduce laws to stop age discrimination. Older people are higher than average users of health services, and the book reports substantial variations in the supply of residential and domiciliary services among member states. In addition, services tend to be fragmented, which makes them harder to coordinate. Some countries provide much less community care than their governments have espoused. In many countries the complicated provision of medical and social services is difficult for elderly people and their families to negotiate. Much of the responsibility for long term care falls on families, particularly women. Yet, with women's increasing participation in the workforce and the restructuring of families that follows divorce, the pool of available women will continue to fall. As the authors note, "A new system of long-term care is urgently required in many countries of the Union, since the predominant forms of care based largely upon filial obligation may soon be impracticable." The Eurobarometer survey found that Europeans believed that such care should be financed either through compulsory public insurance or taxes. The authors focus in depth on Britain, which has some interesting peculiarities. Conservative policies of the later 1970s and 1980s resulted in a shift of services from the public to the private sector. Substantial structural and financial incentives now encourage local authorities to transfer the provision of long term care to private and voluntary agencies. Long stay geriatric care, previously provided free within the NHS, is being replaced by private care for which older people and their families must pay. The book endorses the concept of "productive ageing," but this would require a redefinition of old age policies and practice for Europeans to reap its advantages. These include harnessing the massive resources of talent in the older generation. In both the workplace and community, they could transmit important values, skills, and experience to younger generations, which would simultaneously support high levels of solidarity between generations. As a geriatrician interested in health care delivery in north America, I found this book provided me with valuable insights into healthcare systems in Europe, especially the United Kingdom, with which Canada has many similarities. It was intriguing, hopeful, and challenging for those of us committed to providing quality care for our older population in ways that are both socially sound and fiscally acceptable. Michael Gordon,
head,
Baycrest Centre for Geriatric Care, Rating: ***
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