Old people, joy is coming

This week I went to a small art cinema in Eaux Vives, the area I live in Geneva, to see the movie "No" by Pablo Lorrain. The film is about the referendum that the dictator Pinochet in Chile was forced to organise under international pressure, asking the people for a mandate to continue another 8 years. The people in the No camp, a diverse group ranging from communists, dissidents and Christian democrats, had little time to design a campaign, but were allowed to broadcast 15 minutes each day on national television. They first made short movies about the misery of the Pinochet regime, the people that disappeared and with as concluding message that this should never happen again and that you should vote no. A young marketing professional joins the group and tells them it will not work. People will not want to jeopardize their increase in welfare, will be afraid to vote or will think that change will not happen anyway. The only chance for change is to look at the future and come with a message of hope and humor. After a lot of opposition from within the party (it is not easy to be joyful when your relatives were killed) and from outside (secret police) they do a campaign with the slogan 'Chile joy is coming'. They win, Pinochet has to leave and the rest is history.

Ok, nice story, but what has this to do with ageing and care you might ask? I will come to that in a moment. The first step to explain this is to have a look at the new health policy of the Dutch government.

Essential element of the newest health reforms in the Netherlands is a transition from looking at systems to looking at people. There are not only big differences in health status between people, but also in their social environment and the degree to which they have control over their own life. Despite the fact that different people need different care, we often still give them equal treatments.

The Dutch health ministry wants to solve that by integrating the existing systems for curative care, long term care and social support and to have a much more local and people centred approach in care.

I brought up this policy in an interesting discussion I had in Geneva with a close colleague. As I wrote before, we are organising a meeting with the title "building systems to address functional decline and dependence in ageing populations". For this meeting we write few papers, one of which on functional decline when people get older. The paper summarises the various definitions of frailty, functional decline and disability and how they relate to the different forms of care. There are already nice chronological schemes in the literature connecting different phases in your life to for example chronic diseases management, long term care and palliative care. In other words, your degree of dependency determines what care you need.

In our discussion we had the feeling that this does not reflect the recent developments, for example in the Netherlands, to a more patient centred and integrated care approach. It may be a better way to start not only from health status but also from the social environment and personal characteristics of people to get the full picture. You may then better understand what they need and together decide on the mix of care that will give best results. The mix of care must be such that it will contribute to the overall aim of maximising independence of people over their life course. After all, it is about people's ability to adapt to ageing.

During the meeting we may ask participants to reflect on these issues. But even if we come up with a different format, for me it is interesting to see that there are many similarities to the new health policy back home. We could even radically change the title of the meeting. Not building systems to address decline in people, but building people to address their decline.

But what is the link to the film I started with? Well, you need an optimistic message to change systems. Saying that you will decline later in life, that you are not able to perform functions anymore, that you therefore need care and at the very end maybe even palliative care is not really a hopeful message. Doesn't it sound so much better that it is wonderful to grow older and that our health care and support systems will contribute via a personalized approach to you being as long as possible independent and joyful later in life. As in the film, the dictator/top down approach should make place for the benefit of democracy/ the power of people to have more control over their own lifes. That would be a real revolution! Old people of the world, joy is coming!