Growing Old in the Future

This publication represents the report of the Scenario Committee on Ageing. The draft report was discussed with a wide range of experts, inter alia during the symposium 'Growing Old in the Future' held on October 27th, 1984. In addition to the scenario report, a background report containing the basic analysis employed in the scenarios on ageing has been prepared. The scenario report has been written in such a way that it can be read independently of the background study. Scenarios are a relatively new phenomenon in health care and related policy. For this reason it might be useful to furnish the reader with a few suggestions. As a first step, perusing the summary will provide the reader with an ~verall picture of this application of the scenario method in policy preparation and policy implementation in the sector health of the elderly. As a second step, we would recommend that the scenario report be read in its totality. It might be useful to note down points on which the reader would like to make additions or variations.

Inhalt

Summary.- 1 Introduction.- 1.1 Background.- 1.2 Design and course of the scenario project on ageing.- 1.3 Taking a further look at scenarios.- 1.4 Design of the report.- 2 Scenario A: The reference scenario.- 2.1 Introduction.- 2.2 Demographic developments.- 2.2.1 Population size.- 2.2.2 Composition of the category of elderly.- 2.3 The state of health of the elderly.- 2.4 Social developments.- 2.4.1 Introduction.- 2.4.2 Educational level of the elderly.- 2.4.3 Emancipation of the elderly.- 2.4.4 Reduced number of children.- 2.4.5 Emancipation of women.- 2.4.6 Tolerance of euthanasia.- 2.4.7 Improvement of pensions.- 2.4.8 The position of the elderly in society.- 2.5 The demand for (health) care facilities.- 2.5.1 Introduction.- 2.5.2 The development of facilities.- 2.5.3 GP care.- 2.5.4 Ambulatory mental health care.- 2.5.5 Homes for the elderly.- 2.5.6 Nursing homes.- 2.5.7 Day treatment in nursing homes.- 2.5.8 Hospitals.- 2.5.9 District nursing.- 2.5.10 Home help.- 2.5.11 Dwellings for the elderly.- 2.5.12 Co-ordinated work for the elderly.- 2.6 The economic context.- 3 Medical and medical-technological developments.- 3.1 Introduction.- 3.2 Expectations with respect to medicine and pharmacology.- 3.3 Expectations with respect to technology.- 3.3.1 The costs aspect.- 3.3.2 Medical-technical apparatus.- 3.3.3 Technical aids.- 3.3.4 Nursing.- 3.3.5 Information technology and epidemiology.- 3.4 Towards a second medical revolution?.- 3.5 Expectations with respect to cell biology.- 3.5.1 What is ageing?.- 3.5.2 Biotechnology.- 3.5.3 Immunology.- 3.5.4 Neurobiology.- 3.5.5 Conclusion.- 3.6 Concluding remarks.- 4 Scenario B: Increasing growth in demand for facilities.- 4.1 Introduction.- 4.2 Social developments as they affect the health situation.- 4.2.1 The elderly of the future.- 4.2.2 Values and norms as applying to the elderly.- 4.2.3 Volunteer work.- 4.2.4 Decreasing solidarity.- 4.2.5 Attitudes to sickness and health.- 4.2.6 Increasing professionalization.- 4.3 Consequences for facilities.- 4.4 The economic context.- 5 Scenario C: Decreasing growth in demand for facilities.- 5.1 Introduction.- 5.2 Social developments as they affect the health situation.- 5.2.1 Altered attitudes with respect to sickness and health.- 5.2.2 Work.- 5.2.3 Pensioning.- 5.2.4 Long-term consequences for health.- 5.3 Developments relating to facilities for the elderly.- 5.3.1 Central points of departure.- 5.3.2 Sojourn and care function.- 5.3.3 Nursing and medical treatment (diagnosis and therapy).- 5.3.4 Conclusions with respect to facilities.- 5.4 The economic context.- 6 Disturbing developments.- 6.1 Introduction.- 6.2 Postponement of dementia.- 6.2.1 Justification of choice.- 6.2.2 Some epidemiological aspects of dementia.- 6.2.3 Medical-technological developments relating to dementia.- 6.2.4 Towards a calculation model.- 6.3 Extreme decrease in intergenerational solidarity.- 6.3.1 Justification of choice.- 6.3.2 Some basic data on the aid relationship children-parents.- 6.3.3 Towards a calculation model.- 6.4 Intersecting developments in relation to the scenarios.- 7 Application possibilities for scenarios.- 7.1 Introduction.- 7.2 Scenarios as 'learning environments'.- 7.3. Scenarios and health care facilities for the elderly.- 7.4 A closer look at putting the scenario report to active use.- 7.5 Concluding remarks.- Appendices.