1. Alan Walker Professor of Social Policy and Social Gerontology University of Sheffield, UK and Carol Walker Professor of Social Policy University of Lincoln, UK European Association of Service Providers for Persons with Disabilities (EASPD) Conference on Ageing and Disability, Graz, 8-9 June, 2006 Ageing and Disability: A Quality of Life Perspective

2. Ageing and Disability in Europe Gerontological Evidence on Quality of Life Policy Priorities for Quality of Life ROAD MAP Alan Walker, EASPD Conference on Ageing and Disability, Graz, 8-9 June 2006 Ageing and Disability: A Quality of Life Perspective

3. Ageing and Disability in Europe Ageing and Disability: A Quality of Life Perspective Alan Walker, EASPD Conference on Ageing and Disability, Graz, 8-9 June 2006

5. The Ageing of the European Population Alan Walker, EASPD Conference on Ageing and Disability, Graz, 8-9 June 2006

6. Ageing means more spending on health, social care and pensions A simple correlation between ageing and disability: ageing means more disability The Negative Myths About Ageing Societies Ageing and Disability: A Quality of Life Perspective Alan Walker, EASPD Conference on Ageing and Disability, Graz, 8-9 June 2006

7. Current prevalence rates Projections The compression of morbidity Ageing and Disability Ageing and Disability: A Quality of Life Perspective Alan Walker, EASPD Conference on Ageing and Disability, Graz, 8-9 June 2006

8. Age and Functional Limitation - EU 15 1998 Alan Walker, EASPD Conference on Ageing and Disability, Graz, 8-9 June 2006

9. Disability rates for EU 15 (1999) Ageing and Disability Proportion reporting a physical, sensory or mental disability23% Of whom: reporting severe disability8% Proportion 75+ reporting a physical, sensory or mental disability45% Of whom: reporting severe disability27% Alan Walker, EASPD Conference on Ageing and Disability, Graz, 8-9 June 2006

12. Dependency Projections 2000-2050 Growth in Numbers of Older People with Dependency GermanyItalySpainUK 1.Constant dependency rates121%107%102%87% 2.1 year rise in life expectancy delays dependency by 0.5 years 73%41%79%61% 3.1 year rise in life expectancy delays dependency by 1 year 34%-1%56%35% Alan Walker, EASPD Conference on Ageing and Disability, Graz, 8-9 June 2006

13. Absence of standardised data 2.3% of the population of the EU 15 Range: 1.9% France, Sweden - 3.4% Spain Projections 1995-2020:60+ 77% increase <15 62% increase Ageing with an Intellectual Disability Alan Walker, EASPD Conference on Ageing and Disability, Graz, 8-9 June 2006

14. Gerontological Evidence on Quality of Life Ageing and Disability: A Quality of Life Perspective Professional vs. Lay Concepts Alan Walker, EASPD Conference on Ageing and Disability, Graz, 8-9 June 2006

15. Household Composition Education Labour Force Participation Household Income and Financial Resources Living Standards and Ability to Participate Health Status Family Life Community Life and Social Participation Other Domains eg. housing tenure, life satisfaction Fahey, Nolan and Whelan, 2002 Alan Walker, EASPD Conference on Ageing and Disability, Graz, 8-9 June 2006 Core Life Domains

16. http://www.shef.ac.uk/uni/projects/gop/ Evidence from the UK Growing Older Programme Alan Walker, EASPD Conference on Ageing and Disability, Graz, 8-9 June 2006

17.  having good social relationships with family, friends and neighbours;  having social roles and participating in social and voluntary activities, plus other activities/hobbies performed alone;  having good health and functional ability;  living in a good home and neighbourhood;  having a positive outlook and psychological well-being;  having adequate income;  maintaining independence and control over one's life. Source: Bowling et al (2002) Alan Walker, Current Research in Gerontology and Social Policy, Hong Kong Baptist University, 26 April 2006 The Foundation of a Good QoL in Old Age Alan Walker, EASPD Conference on Ageing and Disability, Graz, 8-9 June 2006

18.  Maintaining health and independence, social activities and relationships,  Neighbourly and safe areas,  Local amenities and services,  Participation,  Transport,  Finance. Source: Bowling et al (2002) Maximising Quality of Life Alan Walker, EASPD Conference on Ageing and Disability, Graz, 8-9 June 2006

19. The Magnificent Seven Alan Walker, EASPD Conference on Ageing and Disability, Graz, 8-9 June 2006

20. Employment Maintenance of Health and Autonomy Care and Carers Social Inclusion/Participation Policy Priorities for Quality of Life Ageing and Disability: A Quality of Life Perspective Alan Walker, EASPD Conference on Ageing and Disability, Graz, 8-9 June 2006

21. Employment Ratio Among Disabled and Non-Disabled People Alan Walker, EASPD Conference on Ageing and Disability, Graz, 8-9 June 2006

22. Demographic Characteristics of Disabled and Non-disabled Working Age Population (%) DisabledNon-disabled Age (years) 16-24 6.417.0 25-3412.625.5 35-4417.723.6 45-5424.919.0 55-6438.414.9 Gender Male47.348.9 Female52.751.1 Educational level Low52.742.7 Medium34.539.2 High12.818.1 Source: ECHP, 1996 Alan Walker, EASPD Conference on Ageing and Disability, Graz, 8-9 June 2006

23. Cardiovascular Diseases (eg. coronary heart disease) Hypertension Stroke Diabetes Cancer Chronic Obstructive Pulmonary Disease Musculosketal Conditions (eg. arthritis, osteoporosis) Mental Health Disorders (eg. depression, dementia) Sensory Impairment The Contexts of Care’ The Places of Care: History and Outlook from XV to XXI Century, Turin, June 18-20th, 2004 Source: WHO (1998) Major Chronic Conditions Affecting Older People Alan Walker, EASPD Conference on Ageing and Disability, Graz, 8-9 June 2006

24. Development of NCD Age ES: socioeconomic status PA: Physical activity Source: Aboderin et al., 2002, p.17 Fetal life SES; maternal nutritional status; birth weight Infancy and childhood SES diseases growth rate Adolescence Obesity lack of PA smokng Adult life Established adult Behavioura l/biological risk factors high Accumulated risk (range) low Scope of non-communicable diseases prevention: a life course approach Alan Walker, EASPD Conference on Ageing and Disability, Graz, 8-9 June 2006

25. Proportion of Disease Burden (DALY) Attributable to Risk Factors (all ages) EU 25 Smoking9.0 Alcohol use8.4 Vegetable/fruit deficiency in diet3.5 Overweight3.7 Fat content of food1.1 Physical inactivity4.4 Relative poverty3.1 Work environment3.6 Alan Walker, EASPD Conference on Ageing and Disability, Graz, 8-9 June 2006

26. Unfortunately and incorrectly people with potentially disabling conditions often are not recognised as a target population for primary prevention effort, despite the fact that having a potentially disabling condition frequently increases the need for good health promotion and disease prevention practices. The Contexts of Care’ The Places of Care: History and Outlook from XV to XXI Century, Turin, June 18-20th, 2004 Pope and Tarlov, 1991, p.105. Alan Walker, EASPD Conference on Ageing and Disability, Graz, 8-9 June 2006

27. Prevalence of Care Dependency in EU Alan Walker, EASPD Conference on Ageing and Disability, Graz, 8-9 June 2006

28. Projected Increase in Numbers of Older People Receiving Formal and Informal Care 2000-2050 GermanySpainItalyUK Numbers receiving informal care119%100%109% 72% Numbers receiving home-based care119%99%119% 92% Numbers receiving institutional care127%120% 81%102% Growth in expenditure120%115% 96%102% Expenditure as % GDP in 20502.721.391.942.75 Alan Walker, EASPD Conference on Ageing and Disability, Graz, 8-9 June 2006

29. Age Distribution of Carers in the EU 25, 2005 and 2030 (%) 20002030 Age Carers providing +20 hrs pw Carers providing +35 hrs pw Carers providing +20 hrs pw Carers providing +35 hrs pw 25-4938 29 50-6438 39 65+24 3132 Alan Walker, EASPD Conference on Ageing and Disability, Graz, 8-9 June 2006

30. Exclusion by self-assessed general physical health Alan Walker, EASPD Conference on Ageing and Disability, Graz, 8-9 June 2006

31. Exclusion by depression status (CESD questionnaire) Alan Walker, EASPD Conference on Ageing and Disability, Graz, 8-9 June 2006

32. Combating age/disability barriers to employment Active ageing: promotion of health and well-being across the life course National strategies for ageing carers Promoting social inclusion: national and local policies Key Policy Directions: Responding to the Policy Challenges Alan Walker, EASPD Conference on Ageing and Disability, Graz, 8-9 June 2006

33. Combat ageist stereotypes (eg. age awareness training) Base support on ability and potential not disability Maintain aspirations and expectations regardless of age Retain the goals of inclusion, participation and choice Initiate health promotion: it is never too late Treat disabled people and their family carers as equal partners in planning their lives Provide a single point of contact with advice on services and social protection Instill a service philosophy based on consistent principles such as social inclusion, empowerment and normalisation Key Messages for Service Providers: Ageing and Disability: A Quality of Life Perspective Alan Walker, EASPD Conference on Ageing and Disability, Graz, 8-9 June 2006

34. Ageing and Disability in Europe Gerontological Evidence on Quality of Life Policy Priorities for Quality of Life ROAD MAP Ageing and Disability: A Quality of Life Perspective Conclusion Alan Walker, EASPD Conference on Ageing and Disability, Graz, 8-9 June 2006

35. THE END THANK YOU Ageing and Disability: A Quality of Life Perspective Alan Walker, EASPD Conference on Ageing and Disability, Graz, 8-9 June 2006