COUNTLESS articles and reports have been written about the crisis in health and social care in Northern Ireland.

We have become accustomed to reading about lengthy waiting lists, ambulance queues, a shortage of doctors in primary and secondary care, and a lack of social care packages.

On almost every measure, Northern Ireland’s health and care system performs worse than anywhere else in the UK.

It is, however, important to note that not all citizens use the system in the same way or to the same extent.

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Older people are disproportionate users, largely due to the higher prevalence of chronic diseases, co-morbidities and frailty.

Whilst they represent a small section of the population, they account for a substantially higher percentage of GP visits, hospital admissions and prescribed drugs.

People over the age of 65 account for approximately 40% of all admissions to hospital and around 60% of hospital day beds.

Those aged 74 and over visit their GP almost four times as often as those aged between 5 and 14, and twice as often as those aged between 45 and 65.

Despite their reliance on the health and care system, many of those who need help and support find it fragmented, inaccessible and difficult to navigate.

A new report published by the Commissioner for Older People for Northern Ireland (COPNI) highlighted the extent to which older people feel ‘shut out’ from a system that they paid into all their working lives.

“Voices of Concern: The Reality of Health and Social Care for Older People in Northern Ireland” is based on the experiences of more than 1,200 older people, alongside demographic, workforce and service data, to illustrate how current pressures are being experienced by those most reliant on the system.

The Older Person’s Commissioner, Siobhan Casey, reveals stark and growing inequalities in older people’s access to services and growing pressures on unpaid carers.

In the face of a rapidly ageing population, the growth of provision has not kept pace with demand.

A legacy of chronic underinvestment, insufficient funding for GPs, the failure to shift from hospital to community-based services, and a social care system desperately in need of reform, have all contributed to a service that it not for purpose.

Despite the fact that the challenges of an ageing population would have been obvious from outer space, little or no progress has been made to address them or plan for the future.

A decade has been wasted since publication of the seminal Bengoa Report in 2016, which advocated for a shift to community care and a focus on prevention.

Inaction, prevarication and blaming others have been the name of the game.

Moving to a preventative model could drastically reduce unnecessary hospital admissions for acute and chronic conditions.

A community-based service could ensure rapid access to occupational therapy, physiotherapy, district nursing and mental health teams.

Including the voluntary and community sector as partners could help to address issues such as assisted living, loneliness, technological change and vulnerability.

The other uncomfortable truth is that ageism is pervasive in health and social care.

The majority of health services are not explicitly rationed, but older people may nevertheless be treated differently or have to wait longer for treatment.

Institutional ageism in health and social care means that health problems in the older population may be characterised or dismissed as normal aspects of ageing.

Fatalism and low expectations about what interventions can achieve for older people are evident in both acute and community health and social care services.

Low expectations on the part of commissioners and providers are self-fulfilling prophecies. Similarly, stereotypes about older people’s mental capacity produces inappropriate and infantilising behaviours.

Talking down to older people is referred to “elderspeak”. This is ageism and using this kind of language is often offensive to those on the receiving end because it is interpreted as patronisng and condescending.

This also includes talking about older patients as though they were not there, or directing speech to another adult or carer.

Historically, clinical trials and medical research tended to exclude older patients.

Knowledge about the impact of treatments on older people is often poor and older patients may be unfairly denied access to some interventions as a result.

Conversely, older patients are at greater risk of complications, particularly through drug interactions, which are not tested in trials of younger subjects.

Self-directed ageism is when these attitudes are internalised by older people, who view decline as inevitable or believe that they are too old or undeserving of care.

This internalisation leads to poorer outcomes as there is a lack of engagement in health-promoting behaviours.

This may involve skipping medication, under-reporting of issues, eating a poor diet, and disengaging from social support.

Individuals may ignore symptoms or avoid seeking medical advance as they believe it is pointless.

“I’m too old” or “I’m done”, “I’ve had a good innings” or “I don’t want to be a burden by wasting the doctor’s time”.

Ageism is one of the last socially accepted -isms, so ingrained in our culture that we barely notice it.

It is not a frivolous issue, but one that is linked with poor health, slower recovery, disability and a reduced quality of life. It can trigger depression, loneliness and reduced self-esteem.

As the numbers of older adults continues to grow, the importance of quality health-related interventions is increasingly critical to maintain population health.

The persistence of subtle discrimination in health encounters can quickly become a deterrent that prevents older adults from accessing care.

This is not just an issue for older people but one that should concern everyone.

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