A damning report exposing the “chaotic ad hoc” system of long-term care for the elderly and the impact of “creeping privatisation” on the nursing home sector is near completion and is expected to be published by Ombudsman Emily O’Reilly next month.
The Sunday Tribune has learned that extracts from the draft report were sent to both the Department of Health and the HSE for their comments last month. Once these are received, a spokesman for O’Reilly – who is currently on annual leave – confirmed that she hopes to place it before the Oireachtas.
The scathing report will detail how many people seeking to access long-term care for the elderly in nursing homes have suffered years of stress and crippling expense because of the “deliberate failure” of the system to clarify their rights to public care.
In a speech to the MacGill summer school last month, O’Reilly also said people were encouraged to go into private care “on the understanding that once a public bed became free they would move. Yet time and time again, that public bed never materialised and the consequences for families were horrendous.”
O’Reilly said her report would show that there has been a “creeping privatisation” of the service, involving a virtual trebling in the number of private home places since 1997 and a significant decline in public beds.
But while the new “Fair Deal” nursing home support scheme system introduced by Mary Harney will make things “a lot clearer and a lot better for many people”, the report will also claim that the state believes it has now divested itself of the responsibility to provide nursing home care.
“The model now is based on the principle that responsibility for long-term care rests primarily with the patient and/or family. The state may support the patient/family financially but this is subject to the availability of resources and to the individual satisfying a means test,” O’Reilly said. “Support under Fair Deal is not guaranteed and the scheme is not a demand-led scheme. If demand outstrips supply then the applicant may be placed on a waiting list until such time as resources become available. There is no legal entitlement to financial support.”
Elsewhere in a speech which was criticised by Harney, O’Reilly referred to a 75-year-old man who rented out his home to pay for private care for his mother while he rented a room from friends.
Archive for the ‘Articles’ Category
Report slams ‘chaotic’ elderly nursing home service
O’Reilly concern at care of elderly
DEAGLÁN DE BRÉADÚN Political Correspondent, in Glenties
Systems to provide long-term care for the elderly are largely chaotic, with many people confused about their rights and entitlements and subject to years of stress and crippling expense, Ombudsman Emily O’Reilly said today.
Although the newly-introduced “Fair Deal” Nursing Homes Support Scheme would improve things for many people, what effectively happened was the State now believed it had no further responsibility in this area.
Speaking to the MacGill Summer School Ms O’Reilly said she would shortly publish an investigation into the operation of this sector over the last number of years by the Department of Health and the Health Service Executive.
“It will tell of a largely chaotic ad hoc system, in which many people were not alone confused about their rights and entitlements but also suffered years of stress and crippling expense because of the deliberate failure of the system to clarify their rights to public care let alone provide for them.”
She added: “I am aware that the new system – the so-called Fair Deal system, the Nursing Homes Support Scheme – will make things a lot clearer and a lot better for very many people, but as my investigation will point out, what has effectively happened through the new legislation, is that the State believes it has now divested itself of the responsibility to provide nursing home care.”
She said while Irish people had fancied themselves as possessing “a great community sense” the fault-lines in the health and social services reflected the lack of a shared approach to the State’s responsibility to vulnerable groups.
Ireland is ranked as fourth-best place to die in world
By Fiona Ellis
Friday July 16 2010
IRELAND has been ranked the fourth best country in the world in a new “quality of death” survey.
The survey, which measured the kind of care given to the dying, was carried out by the Economist Intelligence Unit.
It comes despite a recent damning audit by the Irish Hospice Foundation which examined end-of-life care in Ireland and found serious lapses in the kind of standards expected.
The audit revealed serious differences in the quality patients experienced in hospitals. It also uncovered horrific personal accounts from relatives of people who died in medical facilities.
Yesterday’s survey rated the countries according to the quality of provision of care for those who are at the end of their life.
Ireland beat other comparatively rich countries like the US, Norway, Luxembourg and Canada with a score of 6.8 out of 10. It fell to 17th place, however, for the quality of the healthcare environment, outranked by countries like Hungary and Slovakia.
Commenting on the findings Paul Murray from the Irish Hospice Foundation said, “We are very pleased that Ireland got such a good index marking. However, a lot still needs to be done in hospice care, palliative care and end-of-life care in Ireland.”
The UK came top of the table with Australia and New Zealand second and third, respectively.
- Fiona Ellis
Irish Independent
Groups representing older people call for pension not to be reduced
GENEVIEVE CARBERY – Irish Times
CALLS FOR the pension not to be reduced in December’s budget were made by three groups representing older people yesterday.
They argued that pensioners had already experienced income and service cuts and such a move would place more older people below the poverty line.
Income reductions already experienced by older people included the loss of the Christmas bonus, dental benefit and optical benefit, as well as the introduction of prescription charges and increased fuel costs, said Mairéad Hayes, chief executive of the Irish Senior Citizens Parliament.
Many older people were “hovering around the poverty line” with one in 10 pensioners living in poverty, Eamon Timmins, head of advocacy at Age Action, said.
Despite a public perception that older people had escaped cuts “nothing could be further from the truth”, he added.
Recent service reductions which have made life more challenging for older people included rationing of home help and meals on wheels as well as the cessation of local authority home adaptation and mobility grants, he said.
Increases to the State pension since 2001 were just playing catch-up, said Patricia Conboy, director of the Older and Bolder campaign. Reductions in the cost of living were largely based on lower housing costs which was “not widely relevant to older people . . . In the areas that do affect them, costs have been increasing.” The inequity of private pension tax relief might be a more appropriate focus for analysis, she added.
Exercise ‘may reduce dementia risk’
Exercise followed by a relaxing mug of tea might be a good tonic for the brain in old age, research suggests.
In two separate studies, US scientists found that physical activity and regular consumption of tea or coffee both protect against mental decline.
One team led by Dr Zaldy Tan, from Harvard Medical School, Boston, followed the progress of 1,200 elderly men and women with an average age of 76.
Health checks after an average of 10 years showed that those who engaged in moderate to heavy levels of exercise had a 40% lower risk of developing dementia than the least physically active.
The trend was more evident in men than in women, the International Conference on Alzheimer’s Disease in Hawaii was told.
Professor Clive Ballard, director of research at the Alzheimer’s Society, said: “Whether it be a round of golf, a brisk walk or a session on the treadmill, 30 minutes of exercise five times a week can be beneficial at any age. The best way to reduce your risk is to combine exercise with a healthy diet, not smoke, and have your blood pressure and cholesterol checked regularly.”
The second study, also presented at the conference, suggested that a regular cup of tea or coffee can stave off age-related mental decline.
Scientists led by Professor Lenore Arab, from the University of California at Los Angeles, monitored 4,800 people aged over 65 for more than 14 years.
Participants who drank tea regularly were between 17% and 37% less likely to suffer a reduction in mental ability than non-tea drinkers.
People who preferred coffee were also protected. Drinking coffee more than five times a week lowered the chances of mental decline by 20%.
Depression linked to dementia
“Having depression may nearly double the risk of developing dementia later in life,” reported BBC news. It said that a 17-year study of nearly 1,000 elderly people, found that 22% of those who were depressed at the start went on to develop dementia, compared with 17% of those who were not depressed.
This is a well-designed study and was accurately reported by the BBC. It has several strengths and adds to the evidence of a link between the two conditions.
However, as the researchers say, this does not necessarily mean that depression causes dementia and the reason for the association between the two conditions is still unclear. It is unknown if depression is a risk factor for dementia, whether it is an early sign of cognitive decline or if certain changes in the brain are associated with both conditions. Also, certain lifestyle factors not measured by this study, such as poor diet, lack of physical activity and social interaction, may increase the risk of both depression and dementia.
Importantly, this study was in elderly people (average 79 years) and it is unknown if depression earlier in life would be associated with dementia in the same way. Further research is needed.
Where did the story come from?The study was carried out by researchers from the University of Massachusetts in Worcester, and Boston University in the US. It was funded by the US National Heart, Lung and Blood Institute, the National Institute on Aging and the National Institute of Neurological Disorders and Stroke. The study was published in the (peer-reviewed) medical journal Neurology.
The study was accurately reported on by the BBC, which was careful to explain that depression had not been proved to be a cause of dementia and that more research was needed to find out why the two conditions are linked. However, although the BBC mentions that the study was in elderly people, its story could be taken to imply that depression at any age is associated with dementia later. This study did not look at whether depression earlier in life is associated with later dementia.
The BBC also reported on another paper published in the same journal that found that the more times someone experienced depression, the higher their risk of dementia. This paper is not examined in this appraisal.
Cohort studies are useful for looking at potential risk factors for conditions because they are able to follow large groups of people for many years and to assess how certain events (in this case, depression) might impact their health later. As a prospective study, its results are more reliable than a retrospective study. This is because it tracks people forward in time and can establish any relevant information at the start of the study, as opposed to relying on previous medical records or personal recall. There is also added strength in that it ensured that participants were free from cognitive impairment at the time their depression was assessed.
The researchers point out that some, but not all previous studies have indicated a link between depression and cognitive impairment or dementia. Their research aimed to examine this possible association further over a longer follow-up period than previously achieved.
What did the research involve?This particular study began in 1990, when 1,166 members of the original Framingham cohort attended for assessment. A total of 949 attendees were identified to be free of dementia and were included in the study. Of these, about 64% were women and the average age was 79 years.
The participants were assessed for depressive symptoms, using a validated depression scale that has a score ranging from 0-60, with higher scores reflecting greater depressive symptoms. Based on established guidelines, a score of 16 or over was used to define depression. The researchers also recorded who was taking drug treatment for depression. Of the 949 participants, 125 (13.2%) were classified as depressed and a further 39 (4.1%) were taking anti-depressant medication.
The researchers followed up this group for up to 17 years (average follow up was eight years). Those participants that developed dementia were identified using regular examinations every two years. For this, a well-established questionnaire was used to screen for cognitive impairment, together with other relevant findings from the primary care physicians, medical records, observations from clinic staff and personal observations from the participant and their family. Those with possible dementia had further neurological tests and reviewed by a panel of specialists. Diagnoses of dementia were made using a validated diagnostic tool, and further assessments for Alzheimer’s disease made using established criteria.
The researchers used validated statistical methods to analyse any potential link between depression at the beginning of the study and the subsequent development of dementia. Their analyses also took into account many things that can affect the risk of dementia including age, sex, education, smoking habits, history of cardiovascular disease, diabetes and other relevant conditions.
What were the basic results?During the 17-year follow up, 164 participants developed dementia and 136 of these had. A total of 21.6% of participants assessed as depressed at the start of the study went on to develop dementia, compared with 16.6% of those who were not depressed.
Overall, a total 21.6% of depressed participants developed dementia compared to 16.6% of non-depressed participants. This was equivalent to a 72% increased risk of dementia if the person had depression (Hazard ratio [HR] 1.72, 95%, Confidence interval [CI] 1.04-2.84).
For each 10-point increase in depressive symptoms there was a 46% increase in the risk of dementia (HR 1.46, 95% CI 1.18-1.79) and a 39% increase in risk of Alzheimer’s disease (HR 1.39, 95% CI 1.11-1.75).
When the figures were further adjusted to take account of vascular risk factors such as stroke and diabetes, depressed participants were found to have double the risk of dementia (HR 2.01, 95% CI 1.20-3.31).
How did the researchers interpret the results?The researchers say that their findings support previous studies that have suggested depression is a risk factor for dementia and Alzheimer’s.
Beyond Caring
The Irish Times – Tuesday, July 6, 2010
Beyond caring
HSE cutbacks are putting community health services under strain, causing widespread anguish, not just for the most vulnerable citizens of the State but also for those caring for them at home, writes MARESE McDONAGH
INCONTINENCE PADS are being rationed, there are plans to put home helps on a stopwatch when showering elderly clients, and parents are fretting because some public health nurses are too stretched to carry out infant developmental checks.
Ward closures may grab the headlines, but advocacy groups are on red alert as HSE cutbacks put community health services under strain, causing widespread anguish, not just for the most vulnerable citizens of the State but for those engaged in the thankless task of caring for them at home.
Enda Egan of the Carers’ Association is not easily shocked, but he was appalled recently by the indignity inflicted on some of his members, in the name of saving the HSE a few euro.
Egan was horrified to learn that some carers who dared to ask for extra incontinence wear to make their loved ones more comfortable, were asked to bring in used “nappies” to be weighed.
A small number of so-called “incontinence managers” put carers through this trauma in a crude attempt to measure the amount of fluid passed, in order to calculate if they really did need more than the permitted quota of pads, he says.
“We have come across four cases in two months,” says the Carers’ Association chief executive, who has long waged a campaign to highlight the injustice of having incontinence wear subjected to the “luxury” 21 per cent VAT rate.
Egan believes the HSE is snipping away at community health services because, despite the lip service paid to the importance of caring for our elderly and infirm in the community, “it is an easy one to cut”.
His association estimates there are 160,000 carers in the State, most of them family members who provide three million hours of care per week. There are 40,000 full-time carers, slightly more than the 39,000 nurses in the Irish hospital system.
“Of course, you can’t spot them as easily,” says Egan, who believes the value of the 24-hour care provided by these people is incalculable – and worth a lot more than the maximum means-tested €212.50 weekly payment, which only a fraction of the carers get.
A study commissioned for the Jack and Jill Foundation earlier this year underlines that point. The independent Trinity College report, entitled There is No Place like Home , found that it is nine times more expensive to provide acute hospital care for children with severe intellectual and physical disabilities than to have them cared for at home.
The foundation supports 320 families who care for children at home. But just 19 per cent of its annual €3 million budget comes from the State – and recently it suffered a 6.5 per cent “value for money” cut. Last week, the Minister for Health allocated an extra nurse to the foundation.
But spokeswoman Carmel Doyle points out that recycled mobile phones are still its main source of income. While they have been a spectacularly successful source of revenue, she wonders how long vulnerable children, who in many cases cannot walk, talk, see or eat independently, will be able to depend on the nation’s cast-off phones in order to survive.
For financial reasons, the foundation can only support children up to the age of four but, according to Doyle, more revenue is urgently needed so that it can extend its remit to children aged up to six. “We don’t want to leave them high and dry at four.”
Sinéad Moran, paediatric co-ordinator with the Jack and Jill Foundation, said that 35 children on its books have reached or are about to reach the four-year-old threshold and negotiations are under way with a view to getting the HSE to replace the nursing hours these families are about to lose.
“Many just won’t cope if they don’t get this nursing care,” she says. Moran says there is also a huge issue now for parents of severely disabled children, who find that funding for specialist equipment is drying up.
“These children need special equipment, buggies which support their trunks, special chairs for feeding, walking frames which allow them to stand for maybe 20 minutes a day. They now have to wait months for these things and it is putting a lot of strain on families.”
The foundation provides a nurse two nights a week to the parents of Tommy Simon from Knockarush, Boyle, Co Roscommon, a severely disabled boy who requires round-the-clock care.
“They have been sent to us from heaven,” says Tommy’s father, Frank, who explains that without help at night he and his wife, Niamh, would never get any sleep.
“Our problem is that Tommy will be four in a few weeks’ time, so that is a big worry,” adds Frank. Other parents are worried too.
The Irish Nurses Midwives Organisation (INMO) has warned that the roll-out of the cervical cancer vaccine programme combined with staff shortages means that the ongoing problem of delayed developmental checks for babies will continue.
Labour’s Health spokeswoman, Jan O’Sullivan, says that in many parts of the State, checks which should be done at nine months and which are crucial for picking up hearing difficulties, are being delayed.
“We have also had reports that hearing and eyesight tests, which are usually done on junior infants, have not been done in some schools this year,” she says.
The abrupt closure of respite centres such as Bawnmore in Limerick is causing anguish for carers, many the elderly parents of intellectually disabled adults, who will now never get a break even when ill, she points out.
The closure of the Brothers of Charity facility, which catered for 63 families, has been described by the chaplain, Fr Joe Young, as “the greatest injustice I have experienced in 34 years as a priest”.
The HSE says no decision has been made that has an impact on developmental checks or routine vaccinations in order to facilitate the HPV programme, but some parents say there have already been significant delays.
The HSE acknowledges that last winter’s swine flu campaign, “the largest public health immunisation campaign ever undertaken in Ireland”, led to deferrals of some routine vaccinations and developmental checks. But it says catch-up campaigns have been in place since April.
Claire O’Connor, from Harold’s Cross in Dublin, says her son’s nine-month check is now a month and a half overdue and she is worried about his hearing because he has been getting repeated ear infections.
“I know I can bring him to the GP and I have done that,” she says. “But apart from the fact that it’s €55 every time and I am on unpaid leave from my job, GPs don’t specialise in paediatric care, and I was hoping to have him seen by someone with specialist training who would pick up any problems from a developmental point of view.”
The first time she rang her local health clinic she was told there was a huge backlog and to call back in a month if she was not called.
“I did that but the next time they did not even seem to have me on record and they were telling me that the check can be done any time from nine to 12 months,” she says.
Phil Ní Sheaghdha, director of industrial relations with the INMO, says that if the moratorium is not lifted, public health nurses, still playing catch up after last winter’s swine flu vaccination programme, will be so busy with the HPV vaccine that developmental checks will be further delayed, with potentially damaging consequences.
She stresses that PHNs doing these checks in the home also pick up on other serious issues such as post-natal depression and problems with breastfeeding.
Ní Sheaghdha says there could also be child protection implications if nurses are too stretched to visit vulnerable families. “Sometimes parents don’t want a social worker to call maybe because they are afraid of losing their children, but they don’t have a problem with a public health nurse,” she explains.
Ní Sheaghdha says staff shortages caused by the moratorium on recruitment means public health nurses are not calling to see vulnerable elderly people as often as they would like. “And we have been told that there is a waiting list for palliative care in Kildare. You cannot wait when you are dying,” she says.
Age Action Ireland recently highlighted proposed cuts to home help services, which many working in the sector say could actually put vulnerable people at risk.
The HSE draft guidelines proposed that home helps allocate just 10 minutes to getting older people up and dressed in the mornings, while 15 minutes was the recommended allotted time for helping someone shower.
Ten minutes should be spent getting breakfast and the home helps should spend their visit looking after the client’s “personal care” rather than doing housework or other tasks such as popping out for a litre of milk.
Public health nurses, who are themselves spending less time doing what they regard as essential “surveillance” work spotting potential health problems before they develop, are also horrified at the attempt to speed up home helps.
“How long would it take you to transfer someone from a wheelchair onto a shower seat and get them showered and back out again?” asks one nurse. “Apart from the stress this would put on any elderly frail person whether in a wheelchair or not, can you imagine the consequences if they slipped and fell and maybe broke a hip because someone was trying to meet a deadline?”
Noel Treanor, the INMO’s industrial officer in the northwest, says that early discharges from hospital means an explosion in the number of people requiring support in the community – at a time when the moratorium and the vaccine programmes mean PHNs are unable to do vital surveillance work.
“Not everyone is articulate enough to demand the assessment or the follow-up care they need,” says Treanor.
He points out that because manpower is so stretched, nurses in some regions have been given a list of priorities, which beg the question which services are being put on the back burner.
Maureen Kavanagh, chief executive of Active Retirement Ireland, says it is wrong to even contemplate putting a stopwatch on a home help who is assisting a frail elderly person to have a shower or to get dressed.
“I am concerned that these things are being done from an administrative point of view. Timing a shower is a paper exercise – it has nothing to do with the human.
“I would question whether we are losing the human touch in the health service. If we do, this will not be a good country to grow old in.”
HSE – papering over the service cracks?
Niall Hunter, Editor – www.irishhealth.com]
Our health service currently comes in two versions – the official one that tells us that real reform and progress is being made in delivering better care.
And then there’s the harsh reality that many of us are only too aware of, and which poses a major question mark over the safety of care being delivered.
Much of the HSE’s latest annual report read more like a glossy company report than an account of how a ‘patient-centred’ health service is being delivered. You cannot help but get the impression that there is more emphasis on financial rather than patient outcomes.
We are told that the HSE had delivered services 3% ahead of targets, extra services were provided within budget, that staff numbers came in below projected levels and that savings were achieved through efficiencies and cost containment measures.
The HSE trumpeted the progress it was making in (slowly) setting up primary care teams, in cutting waiting lists (although numbers are starting to rise again, which didn’t get a mention), in opening some new hospital units and services, and in treating 3.4 million outpatients, although again it was not mentioned that there are over 175,000 people on outpatient waiting lists.
However, HSE CEO Prof Brendan Drumm, in one of his valedictory statements as he enters the final lap of his tenure, also told us that staff were going that extra mile to provide ‘more care with less funding’. At first glance this sounds like a good thing – getting better healthcare value for money for our tax dollars.
And it cannot be denied that the HSE under Prof Brendan Drumm has had to live recently in straitened budgetary times, but has managed to root out some waste and inefficiency, as well as recording some successes such as re-organising cancer care.
However, might ‘staff going that extra mile to provide more care with less funding’ also mean ‘staff struggling to maintain safe and quality care with ever diminishing resources?’
Read another report, the latest HSE financial performance report, for the year up to the end of April, and you’d be inclined to take the more pessimistic view.
The report showed us that the HSE, which has suffered a massive €1.2 billion budget cut this year, is finding it difficult to deliver a reasonable standard of service within the unprecedented budgetary restraints it is now labouring under.
The situation is exacerbated by the fact that the pay cuts and income gathering targets aimed at meeting most of the deficit are not being met. The fact that the job reduction target is not being met means that new posts may be denied to vital new services in areas such as cancer.
The HSE’s financial report expressed concern about the effects of the recruitment moratorium on service delivery, indicating that vital frontline staff were not being replaced. The HSE’s deficit for the year is already exceeding €100 million, and while that is small in the context of a €14 billion allocation, in terms of a tight budgetary situation it can mean a lot. And further cuts may have to be made to deal with it.
The HSE has been learning to live on diminishing resources over the past few years. The obvious challenge is how much further can the budget cuts go before the HSE holds up the white flag and says it cannot guarantee a safe service for the money it has at its disposal.
Recent events would indicate that the level of cuts being imposed on the HSE are starting to compromise the delivery of safe and good quality care. And at this stage the warnings being given are not merely industrial relations or vested interest rhetoric.
These worrying developments include:
* Extra beds moved onto wards/beds on corridors to cope with increasing pressure on emergency departments (EDs). Traditional summer decrease in trolley numbers not taking place to any great extent.
* Ambulances delayed at a major Dublin hospital while their trolleys were used for the ED.
* Patients dispersed from an Alzheimer’s unit at a Dublin hospital.
* Some patients requiring MRI scans having to wait three to four months to get a scan.
* Delays in developmental check-ups for infants.
* Continuing cuts in acute bed numbers with no real evidence of transfer of resources to boost primary and community care.
* Growth in numbers on inpatient and day case waiting lists.
* Institute of Obstetricians indicating that maternity units may currently be prevented from sticking to best practice guidelines due to a shortage of staffing and resources.
* Threatened scuppering of plans to hire staff for new cancer services.
* HSE itself admits that it is concerned about the recruitment moratorium’s effect on service delivery.
The crisis the HSE faces in terms of delivering adequate services with less and less money will be the most immediate challenge facing new CEO, Cathal Magee, when he takes over on September 1.
Real Life: Driving into the sunset
Most people can continue to drive into their 80s but some others will have to say goodbye to their car keys much earlier than that. It’s a tricky situation for all concerned
Without so much as a glance to the left or right, her tiny foot exerting minimal pressure on the accelerator, my grandaunt sailed through a red light. Then, seemingly oblivious to the cacophony of screeching breaks and blaring horns, she reached into her cardigan pocket, drew out cigarettes and lighter, and proceeded to light up.
“Why didn’t you stop?” I shrieked, apoplectic. “Couldn’t you see the traffic lights?”
“What traffic lights? Where? Can’t you calm yourself, dear?” was her response.
We drove the rest of the journey in silence. She, lost in thought, puffing smoke out her open window.
Me, on high alert and monitoring her every move, lest we experience a second near-death experience in one morning.
That evening, while the family mulled over how best to break the news that she had to stop driving, she sauntered in, and nonchalantly announced she wouldn’t be using her car anymore.
“There’s too much road-rage out there,” she proclaimed, as we all nodded sombrely in agreement.
While my grandaunt had medical reasons for failing concentration, advancing age in itself is no bar to driving safely.
Dr Conal Cunningham, consultant geriatrician at The Centre of Excellence for Successful Ageing at St James’s Hospital, confirms most elderly people drive quite well into their 80s.
“Because they tend to drive less than they once did and to be sensible enough to take their limitations into consideration, they’re not inclined to have many accidents,” he says.
“The vast majority of cognitively normal elderly folk make the decision to stop driving themselves, or with their families, without any great distress. Many even suggest it themselves when they instinctively feel the time has come.”
That said, accepting that your previously safe driving habits have severely deteriorated due to age can be difficult to take on board. Some, as a manager at a private nursing home in Dublin explained to me, have no idea they pose a hazard on the road, until hard evidence is presented.
“A few years ago, some of the staff noticed that the car of one of the gentlemen who lived there seemed to have more scratches and bangs on it each time he returned from a drive,” he says.
“Their concerns were confirmed when, shortly after that realisation, two of the nursing home’s directors found themselves driving behind said person along a narrow, double-parked street.
“They watched in horror as he hit most of the parked cars he passed only to continue on, seemingly oblivious to what was happening.
“When both cars arrived back at the nursing home a few minutes later and he was asked about what he’d done, the gentleman expressed complete surprise, and it was apparent he was totally and blissfully unaware of the damage he had caused.
“In fairness to him, when he was told what he’d been doing, he accepted he was a danger on the road and he never drove again.”
Not everyone yields so gently to their fate. According to Dr Cunningham, usually those who have problems accepting that they should give up are those who have developed dementia and who, because of that, believe their families and GPs are being unreasonable in suggesting or insisting that they do.
“When that happens, we geriatricians are called upon,” he says.
He’s quick to stress though that many of those with dementia can and do drive safely.
“Fifty per cent of the patients we treat for that condition are fit to drive, and most will be perfectly safe in doing so for several years.
“Of those who have to give up driving because of it, most would be three to five years into the illness before their ability to drive safely would become an issue.”
Physical factors can also cause problems.
“Cataracts, severe macular degeneration and broken hips are just some of the complaints which pose difficulties for drivers,” says Dr Cunningham.
“Stroke too can have an adverse impact, as depending on what part of the brain is affected, behaviour and personality can be permanently impaired, making safe driving impossible.”
The licencing laws dictate that while a 60-year- old can get a 10-year driving licence, those between 61 and 69 can only get one which will expire on their 70th birthday.
After that, when they want to renew their permits, a GP must certify them fit to get a licence for a minimum of one year, or a maximum of three years.
This practice can be highly frustrating for the many able drivers in the 70-plus bracket.
“Some find it difficult to accept those regulations and I can understand why, as while many a 69-year-old could quite safely drive across many continents, they automatically lose the right to a 10-year licence on their next birthday,” concedes Dr Cunningham.
“Also, because life expectancy has increased dramatically over the past 20 years in Ireland, 75-year-olds today tend to be as healthy as 65-year-olds were 25 years ago.”
As to who has the final say on whether a person should be deemed fit to drive or not, Dr Cunningham explains while the GP has full discretion, they tend to call on geriatricians to assess patients who dispute their findings.
“Having conducted our examinations, we often refer them for an on-road driving test, for further insight into their ability, or otherwise, to drive safely,” he explains.
While that procedure may sound fine in theory, the fact that the results of the on-road driving tests can’t be legally enforced would appear to be a flaw in the system.
“It isn’t unusual for drivers to disregard the opinions of family, GP, geriatricians and on-road testers, and to get behind the wheel despite them,” says Dr Cunningham.
“Often, their driving licences and insurance certificates will have lapsed, but that doesn’t always deter them. When that happens, families do whatever they have to do to discourage them from driving.”
The impact on those whose attempts to drive are frustrated by well-meaning family members must be devastating.
Gerry Scully, senior information officer at Age Action Ireland, says: “While some make the transition very well, it’s difficult for others, particularly those for whom it spells social isolation.
“It’s toughest for those living in remote, rural areas, with no easy access to transport, as sometimes their only option is to move house.
“I know of elderly people who had been living just three or four miles outside a village who sold their homes to move in closer when they were forced to give up driving. They felt that without their cars they were scuppered, and that they’d no other options.”
Whatever the circumstances, all of those who have to give up driving have one thing in common.
“For every one of them, it means they are no longer an autonomous human being. From that moment on they’re dependent on family, neighbours, friends and public transport,” he says.
“Families need to be as sensitive as possible to the changing needs of parents who can no longer drive. They need to remember that it’s not enough to take the car keys away, and then go home.
“They need to accept their parents will be more reliant on them, and that it’s up to them to provide whatever support is needed.
“Because of the change in the nature of the relationship between them, the lives of both generations are irreversibly changed from that moment on.”
Julie Meally from Castlecomer, Co Kilkenny, had to keep her late mother from driving when Alzheimer’s disease made it impossible for her to do so safely any more.
“My mother was 65 when I first began to worry about her driving. She was becoming increasingly forgetful.
“Sometimes, she’d forget where she’d parked the car, and while we’d go hunting for it together, it was tough.
“For her, the car meant independence, but more than that, it was her passion and her prime social outlet
“She was 70 or 71 when my siblings and I took the keys from her. We felt we had to when we discovered she was asking neighbours for directions when driving home from my house, a trip she’d been making for years.
“She continued to ask for the car keys for a year or more after we took them. She’d see her car through the kitchen window and pine, so we’d tell her it was broken and couldn’t be driven anymore. We also told her that as her doctor hadn’t certified her as fit to drive, her licence couldn’t be renewed.
“This wasn’t actually the case, but we felt we had to do whatever we could to keep her off the road, lest she hurt herself or someone else.
“Throughout, we had the utmost respect for her, and having to be untruthful to her was really difficult for us.”
- Rita de Brun
Irish Independent
Wave goodbye to OAP surfers?
INTERNET training for the elderly could become a thing of the past if a programme run by Age Action Ireland is axed, writes Marian Harrison.
The Getting Started programme has trained more than 5,000 people since 2007, with funding coming from the Department of Communications, Energy and Natural Resources under a Government scheme for digital inclusion.
However, that scheme ends later this year and fears are mounting that it will not be renewed or replaced.
Age Action’s development officer, Helen McQuillan, says the programme has transformed the lives of those it has taught, providing them with basic computer skills. It is currently running in 12 of the 26 counties.
“The programme shatters the stereotype of older people being reluctant learners, fearful of new technology. Instead, learners on the programme have qualities such as enthusiasm, energy, drive, curiosity, desire for new challenges and a sense of competence and self-direction. This proves that learning about new technology in the right environment is closely linked to positive aging and well-being.”
With more than 1,000 older people in Ireland on waiting lists for courses, Age Action chief executive Robin Webster says the need has never been greater to secure funding from the private or public sector in order to ensure the programme continues.
