14 Comments
Jan 18Liked by John Quiggin

I furiously agree. The only thing I would like to add is that boosting population growth in order to provide a work force for the future to look after the elderly in their final years always causes me to mentally scream with frustrated rage – are we expected to continue this strategy ad infinitum? This is as silly as perpetual motion machine theory.

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Jan 18Liked by John Quiggin

The analysis could do with extension to medical costs. These are also concentrated in the first first and last years of life, and show the same swings-and-roundabouts pattern as those of care: with an ageing population, they go up for the aged and down for infants. But the nightmare cases are I suspect very asymmetric. Only a few disturbed or disabled children need the sort of continuous attention of a sufferer from Alzheimer’s.

The prevalence of this plague has shot up, from 19.7m cases worldwide in 1990 to 51.6m in 2019 (+161%) (https://www.frontiersin.org/articles/10.3389/fnagi.2022.937486/full). “An estimated 6.7 million Americans age 65 and older are living with Alzheimer's dementia today[2023]. https://pubmed.ncbi.nlm.nih.gov/36918389/

The general expectation is that this growth will continue. There is the usual hope that like cancer, this recalcitrant non-infectious disease will finally yield to the large-scale research being thrown at it, and/or to the drop in air pollution we can confidently expect from the energy transition.

If you are looking for some thing less conventional, yours truly floated an oddball hypothesis in a blog post back in the High and Far-Off Times of 2011: http://www.jameswimberley.es/Blog%20posts/2011/Easy%20lies%20the%20head%20%C2%AB%20The%20Reality-Based%20Community.htm

SFIK nobody picked it up, for confirmation or refutation. However, the initial observation holds up: European royalty stay healthy as they age. Elizabeth II of the UK died at one of her many homes at age 96, following her husband who died at age 99 and her mother at 101. Two days before her death Elizabeth received Liz Truss as incoming PM, an important constitutional requirement. Queen Margarethe of Denmark has just abdicated at her own initiative at age 83. She walks with a stick. Queen Beatrix of the Netherlands abdicated at merely 75. And so on.

In the post I asked why they are so healthy and keep working long after most of their subjects. The glowing health of royalty presumably translates to low lifetime medical expenditure. They seem to be reasonably active physically – only a few like Anne of the UK (equestrian) and King Harald of Norway (sailing) have competed in any sport at a high level. The work is light and not very stressful, though it does require constant self-control to interact civilly with the assorted psychopaths, fans, flatterers, conmen, paparazzi and random citizens they are paid to face on a daily basis. They are well off, more securely so than most rich people. Since royal titles, unlike capitalist fortunes, are entirely a matter of luck, and the inbreeding stopped a century ago, it’s unlikely there is a genetic secret sauce.

Here’s my additional pennyworth. From before birth, they all got the very best preventative medicine and advice available at the time, which trickles down to the general population after a lag. That component of a healthy and low-cost age is now available to everybody, and some but not all of the other environmental factors can be made so in future. I still think it would be worthwhile to spend a little to research the anomaly properly.

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Jan 19·edited Jan 19Author

It's not just royals. In the last five years or so, it's become unremarkable to see obituaries for people who lived a century. Given the timing, this includes lots of people famous for things done in World War II, when they were in their 20s. The first time I noticed this was with Vera Lynn (died 2020 at 103).

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I'd be willing to bet a fair amount that the mean age of death of pop singers is quite a bit lower than that of royals. No disrespect intended to Dame Vera and the many she cheered up. Find me a royal who died young recently. Even Margaret lasted to 71, and she worked pretty hard at unhealthy living.

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Dementia is the big one, largely because it used to kill people quickly in the days of home care, and now does not. But age-specific dementia rates are falling, with improved fitness and healthier living.

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PS. Age-specific rates: so what? Everybody lives longer and hits the off-ramp later, whatever it is. But I Am Not an Epidemiologist.

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Source? I ask because the Xue et al paper, my first link, gives the overall incidence of dementias in Australasia as 0.02 per million in 1990 and 0.005 in 2019 (Table 1). Prevalence - the total number of cases, the more relevant indicator for care - naturally went up even more, from 0.15 per million to 0.38 (Table 2). Alzheimer's accounts for roughly two-thirds of dementias https://www.sciencedirect.com/science/article/abs/pii/S1064748112610562

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Jan 20Liked by John Quiggin

Something wrong with the units: it should be absolute numbers in millions, not rates. The 2019 prevalence for Australasia is 0.05, not 0.005. So 50,000, of whom ca. 40,000 in Australia.

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Jan 18Liked by John Quiggin

Certainly we don’t need more young people to look after elderly people. However we will need more highly trained health professionals to provide quality care. Of course the real elephant in the room with a growing population is sustainability. What is a sustainable population in a country that has poor soils and issues surrounding access to potable water. https://www.sustainableaustralia.org.au/population

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No (we don't need more kids to take care of us when we get old)

To begin with ~ what is 'old' ~ 60? 70? 80? 90? Old is probably when you start apologising for not seeing the sense in the latest gadget. You mightn't like it but just say so. I prefer manual cars because driving a car is so boring, I have to have something to think about doing while in the process of doing it.

I do lobby for better public transport and older people who aren't working or grand-parenting (which can also be work) would be most effective at forming angry mobs against the dismal tide of car usage. They could rebel and lobby for many causes because 'old people' are meant to be stoic and just potter in their gardens or around galleries. Angry oldies would be a force to be reckoned with.

' Oldies' should be able to reach a better old age. Everyone should be educated from a young age concerning the benefits of a good, healthy diet and exercise. Tax sugar! Government should play a role in this and it should also aim for a variety of housing options so that if an older person wants to downsize from ownership or rental, they can find suitable accommodation, independently, or shackled to a lifestyle village which suits them and is accessible to family, friends and services.

But people should not be created to serve someone else. They should be there to find the most satisfying and rewarding role for themselves.

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Jan 18Liked by John Quiggin

3.7% of workers in Australia are engaged in the finance and insurance sectors, so if we got really desperate we could redeploy half of them to aged care with no loss of social welfare. There's also 9% of workers in retail -some of that work makes people's lives better, but a lot doesn't. There's no greater measure of a society than how its people spend their time.

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You missed the number of residents in this sentence. "Staffing requirements in Australia amount to aroundone full-time staff member per residents."

I have family working in aged care. From what I've been told (which is supported by many media reports), nursing homes are badly understaffed and staff usually end up doing a significant amount of unpaid overtime. Even with the unpaid overtime, patient needs aren't being met. So whatever you think the staff requirement is, I'd say add 25% .

Regardless, if we prioritise social expenditure over low taxes (as I think we should), I think we can easily meet the needs of an aging population. Even as a dad and husband with a below average income, I can easily afford to pay a bit more tax, while the 1% can afford to pay much more tax.

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I took a while over this. The regulations require about one carer per eight residents per shift, with four shifts, but there's a roughly equal number of backup staff for cooking, cleaning admin etc. Hopefully not too far off the mark

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First full agreement with arguments against declining populations leading to excessive costs whether aged care or just "retirement" income and medical care. These can be dealt with, in part by extending years of healthy productive participation in the labor force.

"Policies aimed at changing those choices [leading to population decline] will have costs that exceed their benefits."

Since we have no idea what those policies might be, it's hard to say that they WILL have higher benefits than costs. There are policies that point in a "natalist" direction that do not have costs: a) reducing the opportunity cost to women's careers of pregnancy and child rearing, b) changing land use and building codes that make building smaller "starter" residencies where people want them more difficult, c) more progressive (= age progressive) taxation.

And as a matter of policy, why and to what extent is not working later in life more worthy of receiving transfers than not working during child-rearing ages?

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