Guardian of the longevity dividend

Prof Des O’Neill, consultant geriatrician at Tallaght hospital, Dublin, has one of those mind-boggling curriculum vitaes that leaves you dizzy after reading it.

His extensive involvement in old-age medicine includes being the co-founder of the European Union Geriatric Medicine Society, the first medical director of the Alzheimer Society of Ireland, and author of the Leas Cross report, which was the first major review of sub-standard care in nursing homes in Ireland. He is also the current chairman of the National Centre for Arts and Health.

He has published more than 300 peer-reviewed papers and chapters and was awarded the All-Ireland Inspirational Life Award in 2010 for advancing the cause of older people in Ireland.

Practical manual
Readers of Health + Family will already be familiar with O'Neill's expansive views on ageing from his monthly column and now he's written his first book, Ageing and Caring – a Guide for Later Life (Orpen Press), which is a practical manual full of information and advice on all aspects of growing old in Ireland.

Why did he write the book with so much diverse sources of information out there already?

“Well, I bought about 30 books on the subject and realised that nearly all of them were oriented towards the spouse or adult children.

“Very few addressed the older person him or herself,” says O’Neill.

Even a quick skim through the book will show you that O’Neill is a frank advocate of how what older people want and need isn’t always the same as what their adult children want for them.

“Older people recognise what they need as they age and the agenda of the carer has shared and divergent elements in this.”

He continues: "We used to have family meetings when there was a complex discharge from the hospital and we came across units where the patient wasn't at that meeting. Now, we have care planning meetings and the person states who should come from the family."

'Positive experience'
Speaking about why he chose geriatrics as his specialty, O'Neill says: "I had a positive experience of older people as a child [the fifth of eight children] and that of my parents' relationships with their parents.

“Our house often had older people in it and I saw them as fascinating and interesting.”

All four of his grandparents did, however, develop dementia and all spent their last days in nursing homes.

He cites a gap year while studying medicine at Trinity College Dublin in the 1980s as a particularly formative experience.

"I volunteered with Les Petits Frères Des Pauvres in Marseilles, France. There was a deep and intensive homecare programme for older people which celebrated birthdays, holidays and special days. This view of older age as a time for celebration stayed with me."

O’Neill says that when working in Britain as a young doctor, he was greatly influenced by visionary and radical medics there.

"People like Bernard Isaacs who said, 'If you design for the young, you exclude the old; if you design for the old, you include the young.'"

'Best-humoured department'
Now, after 20 years working as a geriatrician and stroke physician in Ireland, O'Neill says: "It's not only intellectually stimulating, emotionally and professionally rewarding but also generally the best-humoured department in the hospital.

“I was the eighth geriatrician appointed in Ireland and now there are over 70 geriatricians.

“Geriatric medicine and old-age psychiatry here are above the European average and attract very high-calibre trainees.”

While he acknowledges shortages of therapists (such as occupational therapists and psychologists in dementia care), he worries about the constant negativity about health services in Ireland.

“The media perception of healthcare in general and the public discourse on healthcare paints it in a much bleaker light than it is,” he says.

He suggests putting some kind of fee on the medical card for those over 70 would be preferable to giving it only to those on lower incomes – simply because the medical card is the easiest access point to numerous health and social services for older people.

On ageing itself, he believes there is an over-simplistic rhetoric around ageing as loss.

“Older people do suffer loss through death and mobility and financial constraints. But from 50 onwards, we gain in strategic thinking, wisdom and the sizing-up of the safety of situations. Older people are both tough and frail.

“And loneliness peaks under the age of 25: I always think that the antidote to loneliness for those under 25 is quantity of contact; the antidote to loneliness for older people is quality of contact.

“Even we, as medical professionals, have to be careful not to make ageing just about falls and incontinence. We are the guardians of the longevity dividend,” he says.

Family support
Now 56 and husband to occupational physician Mary Boyle, who worked outside the home until the arrival of the couple's fifth child of seven (aged between 23 and 12), O'Neill isn't yet thinking about his older age.

“I’m not troubled at the age I am. I cycle to Tallaght hospital from my home in Terenure every day so that keeps me fit. I have a very supportive family environment. It’s a busy life but I’m getting better at saying no to things.

“Writing is my hobby. I love reading and classical music and we’ve spent two weeks in Kerry every summer for the last 10 years.”

The family recently experienced the death of O’Neill’s mother-in-law who had lived with them for the last eight months of her life. “My wife provided amazing palliative care to her and it was hugely important for the children who enveloped her with care and attention even as they continued with everyday life.

“Caring is a part of our development as human beings. We are the better for caring for someone.”

Ageing and Caring – a Guide for Later Life by Des O'Neill is published by Orpen Press.