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Elderly 'have internalised' message they're a burden on society, says physician Karen Hitchcock

Video and transcript inside: Dr Karen Hitchcock: "My core message is that we really need to think about our ageing population as a triumph and really rethink what it means to be old and what it's possible to do when you're elderly. Most elderly people are not sick, most of them are not in nursing homes, but I think we can do a lot more to integrate elderly people back into our communities and try and reimagine what it is that we want our communities to be. I think we need to start from an ethical perspective of what we want our community to be, and then from that, imagine our society and then find ways to create it and fund it, rather than starting from an economic position." Congratulations to the 7.30 Report, Karen Hitchcock and Quarterly essay for criticising the appalling depiction and treatment of Australia's elderly, implicitly and explicitly advocated by the growth lobby in the mainstream media and government. See, for instance, "Should Jeannie Pratt and Elisabeth Murdoch downsize to high rises in Activity Centers to give young people more room?" The negative message about the elderly has been so overwhelming that most of us find it exhausting to fight. The ABC has often also carried this message uncritically. Perhaps it took a woman-led news commentary program - the 7.30 Report - to try to break this mould. Dr Karen Hitchcock (who is a staff physician in acute and general medicine at a large city public hospital) is a very effective ambassador for the elderly, although she is a young woman herself. Her work deserves our collective support and promotion.

Video and transcript originally broadcast and published from the ABC 7.30 Report at on 12 March 2015.

Elderly 'have internalised' message they're a burden on society, says physician Karen Hitchcock


Australian Broadcasting Corporation

Broadcast: 12/03/2015

Reporter: Leigh Sales

Discussion on our ageing population and their use of the healthcare system is sending older Australians a message that they're a burden to society, suggests a physician at a major public hospital in Victoria, Karen Hitchcock.


LEIGH SALES, PRESENTER: By 2050, about five per cent of Australia's population will be over the age of 85, with many of us expected to live to our mid-90s. The challenges of the ageing population are something we've been hearing a lot about in the past couple of weeks, since the Federal Government released its Intergenerational Report. The message is that more old people and falling budget revenues are going to put a huge strain on our health and welfare systems. But now one doctor is raising concerns about the way we're discussing the ageing population. She believes we're sending older Australians a message that they're an intolerable burden.

Karen Hitchcock is a staff physician in acute and general medicine at a major public hospital in Victoria and she's written the latest issue of the Quarterly Essay. It's entitled Dear Life: On Caring for the Elderly, she joined me from our Melbourne studio.

Karen, we've been talking a lot recently about the economics of health care as the country deals with an ageing population and declining budget revenue. When you listen to economists and politicians talk about the ageing population and the growing pressures on the budget and sustainability and so on, as a doctor, what do you hear?

KAREN HITCHCOCK, PUBLIC HOSPITAL PHYSICIAN & AUTHOR: What I hear is that the fact of our ageing population is an overwhelmingly negative development. The elderly are portrayed as being a burden on their families and on the state and a drain on the economy.

LEIGH SALES: And what message do you think that the elderly hear?

KAREN HITCHCOCK: Oh, I think that they've completely internalised this message that they're a burden. I see evidence of this every day on my hospital ward. Patients, elderly patients apologise for being sick, for being in hospital, for taking up a hospital bed that should be apparently for somebody else.

LEIGH SALES: How does that translate then in terms of the type of care that they want?

KAREN HITCHCOCK: Well, I think that sometimes it can mean that they feel reluctant to accept the care that they need.

LEIGH SALES: Like, give me an example of, say, a patient where you've seen that.

KAREN HITCHCOCK: Um, well, I've - there's a lot of patients, but recently I looked after an elderly gentleman who said that he wanted to die and that he didn't want to be in hospital and that he was a nuisance and when I sat down and talked to him, it turned out that his wife had recently died, his dog that was his remaining companion had died and he felt that he had no place in society anymore and that he was a burden.

LEIGH SALES: And so how, as a doctor, did you address that?

KAREN HITCHCOCK: I called him a couple of weeks after he left hospital, given that he had said he never wanted to come back to hospital, just to try and work out a plan for him and he said to me that he says silly things when he's sick. Of course he wants to come back to hospital and that he was very, very happy because he'd managed to get another dog, go back to his part-time work.

LEIGH SALES: What's your attitude towards advanced care directive, which are documents that people sign giving instructions about the sort of treatment that they would like if they're faced with potential end-of-life issues, which of course is often things that older people sign?

KAREN HITCHCOCK: They're being heavily promoted at the moment as something that should be universally adopted and I think that they do have a place, particularly if people have advanced malignancy and are going to die imminently or particularly when people have particular treatments that they don't want to have. But I think that saying that every single citizen in Australia should have an advanced care directive is dangerous and I think that to say that they're unambiguously good sort of relies upon an understanding of the human subject that is breathtakingly simplistic. People change their mind. It's very difficult for us to know how we're going to feel as we become increasingly dependent and debilitated. I mean, my grandmother, for example, she was a fiercely independent woman who, in her 80s, developed a lung disease that meant eventually she was house-bound and oxygen dependent. And if someone had've asked her a year prior to that development whether or not she would rather die or be house-bound and oxygen dependent, she definitely would have said she'd rather be dead. But when it came down to it, she was very happy with her life. She still had her family. She said that she would play in her memories. She was very happy to be alive.

LEIGH SALES: So if you see this idea that we are giving elderly people the impression that they're a burden as being a problem, how would you like to see the debate around some of these issues and the discussion reframed?

KAREN HITCHCOCK: Well I think that our focus should be on how can we improve the life of our elderly patients, not that we should be so keen to offer them death.

LEIGH SALES: And so, practically, how would you go about doing that?

KAREN HITCHCOCK: Um, I think that we - it would be really helpful if we could somehow integrate medical and social services so that we can encourage elderly people to remain independent and in their communities. If we could somehow integrate services and offer preventative treatment before people need to come to hospital, that would be a really great development and there are international examples of care programs like this where there are community-based, what's called medical homes, that are staffed by GPs and specialists and full allied health to enable people to stay in the community longer and to stay well and independent.

LEIGH SALES: How about the interaction between nursing homes and hospitals, how well does that work?

KAREN HITCHCOCK: It works very poorly. Many elderly people come to hospital as a result of medication side-effects, having too many tablets or etc., and they come to hospital, we stop their tablets and they're discharged back to their nursing homes and they have to continue on the tablets that they were on prior to coming to hospital, sometimes the tablets that caused them to come to hospital, until they can get a doctor to come to the nursing home and rechart their medicine.

LEIGH SALES: You are a busy doctor, yet you've taken the time out to write this lengthy piece of work around these issues. What is the core message that you're hoping to get out there based on your experience working in hospitals?

KAREN HITCHCOCK: My core message is that we really need to think about our ageing population as a triumph and really rethink what it means to be old and what it's possible to do when you're elderly. Most elderly people are not sick, most of them are not in nursing homes, but I think we can do a lot more to integrate elderly people back into our communities and try and reimagine what it is that we want our communities to be. I think we need to start from an ethical perspective of what we want our community to be, and then from that, imagine our society and then find ways to create it and fund it, rather than starting from an economic position.

LEIGH SALES: Just before you go, Dr Hitchcock, there's been a lot of discussion around this week about sexism in medicine. A senior surgeon raised some concerns around the issue of sexual harassment and whether or not raising that impacts on female doctors' careers. Just in your experience, do you think that there is a problem in medicine with sexism?

KAREN HITCHCOCK: I've obviously not worked with every doctor in every hospital in Australia and I'm sure there are individuals. However, one thing I do know is that there is certainly not a pervasive culture of sexism in medicine. I've never been discriminated against because I'm a woman in medicine. In fact I've been enormously supported and encouraged.

LEIGH SALES: Dr Hitchcock, thank you very much.


Image icon dr-karen-hitchcock.jpg7.01 KB


By 2050, about five per cent of Australia's population will be over the age of 85. There is a lot of fear being raised about the terrible threat of an ageing population, with an escalation of all these "leaners" being added to our economy! They are being treated as unwanted burdens, and thus each of us in the future will have to work more!
Many older people in other societies are treasured and respected, and honoured for their contribution to society and help for families and communities. Now, they are being vilified and blamed for the all our economic woes. The whole Ponzi nature of our economy is winding down, and depends on "new" people - so now we must have bit immigration to dilute their numbers. It's about an irrational fear of ageing and using the older people as a scapegoat for justifying "growth" and further downward spiralling of living conditions in Australia.

Today I received this comment, with the accompanying URL, "I think the middle and lower middle class in Australia is under severe attack!"

A 'productivity' commissioner is trying to con people into thinking that more and more people need to cash in their homes, based on a perception that pensions are too dear to pay. The cost of living in our society is actually extremely high due to high immigration (artificially accelerated population growth) inflating the price of land, housing, rent, water, and power. If we reduced population growth, rents and all costs would greatly decline. We would neither have to work so much nor would it cost so much for us to retire. But our government and its elite cronies benefit financially from all this inflation because they have put themselves in a position to do so, by privatising our assets and speculating on them.

The rest of us are blamed for this because the cause is not acknowledged and our population is being made more and more insecure, unable to bargain for wages, nor resist oligarchical economics.

The push to fund retirement with the family home begins with 'very valuable homes' but the value of homes is artificially grossly inflated and the media is trying to characterise ownership of any home as asset hoarding, as if elderly people, indeed anyone, did not need to live somewhere.

The solution is elegant, tried and true by normal societies, but our governments and elites are simply too dishonest to admit this. Below is a link to an article which explains how all these costs could be brought down:

Discussing Australia's Dependency ratio 2009 with graph by Dr Katharine Betts

We look at Dr Katharine Betts's latest graph of ABS statistics on the ratio of working to dependent in Australia, noting that it is both untrue and discriminatory to imply that the 'Aged' are by far the biggest group of 'dependents.' In relation to the graph, we also look at the role of land-use planning and the social division of work in industrial society in creating financial dependencies where none previously existed. We note that established financial and institutional investment in the post-war industrial-contractual model makes it inflexible and resistant to changes in economic feedback, but that change it must as fossil fuels deplete. Left to their own devices, Australians would probably return to the human default social organisation around kin and place, which is flexible and low cost. This will only become possible, however, with cheaper land and an economic system which permits increasing relocalisation and more flexible use of land than the current plans for packed appartments and dense dormitory-suburbs anticipate.

What we are heading for is closed shop capitalism where most of the population will not be able to participate at all. The idea promoted by the Productivity Commission in the above comment renders elderly home owners ineligible for the Age Pension until they become only part owners or non-owners. This means probably, in those cases virtually no wealth will be passed down to the next generation. This is a disincentive to save and to do other than rent during one's working life. This will particularly affect the lower middle classes. The middle classes may be self funded retirees but who knows? The Productivity Commission may later come up with a way of making even them sell their houses in order to receive a pension they've saved for during their working lives in their super funds!

So the direction is towards focusing capitalism on the big end of town at the expense of ordinary, average people. They will be locked out of even the crumbs from the system.

The Productivity Commission should be recommending higher levels of productivity, and economic stimulus, not clawing at the houses of older people. Some of these high-valued houses are not because they have become tax havens, or hidden income stores, but simply have been artificially inflated in price due to many investment schemes, international demands and high population growth. Homes are for families, lifestyles, and the most precious asset of many people. How can the house be liquidated to pay the bills, buy food and then have nothing to pass onto future generations? Personal wealth is being dismantled, and drained to governments to keep up the Ponzi scheme called "economic growth". There should be more honesty that we are nose-diving into desperation to get revenues and that the system is failing. Population obesity is a malignancy.

ABC news

Medibank Pivate’s profits have soared . They are going to limit their exposure (or a similar word) to high risk groups such as “the elderly”. Just shows that Health insurance as a profit making business is incompatible with a service to people. Seems "the elderly” are being targeted all round- their houses will become payment for their pensions, their Health insurance premiums will rise and their drivers licences will be confiscated!

The government should not subsidise this insurer.

Productivity is defined in economic terms as is the effectiveness of productive effort, work rate, capacity yield ie input versus output. Why then for all of man's improved methods of production is productivity waning? For centuries we have been refining our skills, improving work place conditions and introducing modern technology, and yet productivity declines.

This may be because we are not looking for productivity in the right places or maybe we are applying the wrong definition of productivity. Ecologically productivity means fertility, fruitfulness, richness, etc. If we take this definition further to describe worker satisfaction, I believe that the definition of productivity may take on a completely different set meanings: imaginative creativity, self-satisfaction in the work that you perform, the ability to make the world a better place, the co-operative effort to move mountains, etc.

However, the modern context of productivity is to take the economic definition and to put a a neoliberal slant on it whereby the context becomes "you'll do the job my way, I'll pay you less and if you don't like it I'll take my business off-shore and you can rot in hell"!! I don't know if you call that a Ponzi scheme or not, but probably a bit more like some kind of modern feudalism. And I do agree with your last sentence, only that it's a global phenomenon.

Part of the issue is that because property prices have skyrocketed, it's not changed merely the dollar value, but the way we look at houses overall.

Because your average suburban house has gone from a large personal expense to a gold mine, it is inevitable that there would be added interest in capitalising on this.

Part of this is what is leading to so much subdivision and towers. Because the land is increasing in price, the appeal of such developments also increases. Also, as the price is increasing, so to is the temptation to draw on that profit. On one hand, retirees are "cashing in" by destroying their backyards to create a unit, on the other hand, there is renewed interest in liquidating those assets to get that money flowing through.

It is naive to think your suburb can increase in value three fold, and nothing would change. Anyone who cheers their home price increasing in value AND complaining about development, traffic and predation is clearly an idiot. It's like your car increasing in value four fold, then complaining it is a greater target for theives.

Well DUH!

As property prices fall, so will the absurd developments and the call to get pensioners out of their homes. It just won't be as profitable to do so.

good graphs.
Quote -

"Alan Woodward, board director at Suicide Prevention Australia, linked the rise in suicide among middle-aged Australians to deteriorating quality of life, chronic health problems and age-based discrimination."

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It is obvious to me that life for ordinary Australians is going downhill. There is no unconditional acceptance into the Oz community. The media pogrom against "Baby Boomers” is enough to make people give up.

Four Corners also recently ran a special on the Commonwealth Bank of Australia (CBA)’s insurance arm- doing all in its power to avoid payments to legitimate claims leaving a litany of misery and sacking the whistle blower of course. Such financial practices drive suicides.

I'm sure that the powers behind our State and Federal governments actually want this, even if the politicians prefer to pretend that everything is under control.

There's no stability in Australia, no predictability and nothing to ensure young people now of the future. They are likely to be be struggling with unemployment, and/or landed with heavy debts if they dare to take on training or tertiary education. Housing is unaffordable, and so are rents. Despite our high immigration, and the desire of many people to come here, those who here are not living the most enviable lives! Once we become older, we are then part of the dreaded "ageing population" pulling down our economy, and draining the public of costs!
"Baby Boomers" are now "rich", because we come from an age in which Australia was wealthy, and lucky, with only a small population. They are easy picking too for taking the blame for the poverty of this generation, and of hogging up houses that should be pulled down to make room for units!
Families end up divided due to high cost of housing, and lack of jobs.
Australia is going downhill, and there are more and more savage cuts to our budgets, but the growth machine keeps rolling out fake promises of wealth at the end of the rainbow- once we have more people, taxpayers, to fill our coffers. The lies are easily seen through. Lack of hope, usefulness and deprivation is the cause of so many suicides.

The group which has the highest suicide rate in Australia at the moment are males aged over 85. Our profit/greed driven society has changed our view of society from one of community to one where it is nothing more than an agglomeration of people seeking to maximise profit. Older people have gone from experienced human beings to being seen as an economic sink.

However, unless we address the underlying philosophy behind how we drive and run our nation, no hand waving or statements to treat them with respect will alter this. We've created for ourselves a system which everything is subservient to finance, one which has no room for anything else.

But this system has been a long time coming. It was baked into our society decades ago. We are only noticing it now because the art of raw capitalism is finally being refined, it is becoming a perfected science. We can trace the origin to the "economic rationalism" of the late 80's and early 90's.

Australia's suicide rate rose to 12 per 100,000 people in 2014, according to Bureau of Statistics figures released on Tuesday – the highest level since 2001, when it reached 12.6 per 100,000.

The suicide rate among those aged 55 to 64 years surged by 54 per cent in the 10 years to 2014, to 15.1 per 100,000. However, men made up three-quarters of the 362 suicides in the age group 15-24 in 2014.

It seems that men, once they decide to kill themselves, are more successful. Suicide was the leading cause of death for Australians aged 15 to 44, while the rate for men was nearly twice the rate for women. Men worry about money, supporting their families, being the breadwinner. High levels of unemployment, and underemployment, no doubt threaten the men's self esteem and status.

Alan Woodward, board director at Suicide Prevention Australia, linked the rise in suicide among middle-aged Australians to deteriorating quality of life, chronic health problems and age-based discrimination.
Australia was once a wealthy nation, the envy of the world, with affordable housing, and full employment. Thanks to economic rationalism, greed, poor leadership, inhumane and cruel politics, Australia is on the slide.

Economic rationalism is the dogma which says that markets and money can always do everything better than governments, bureaucracies and the law. There’s no point in political debate because all this just generates more insoluble conflicts. It's neo-liberalism, in allowing markets and the economy to make the rules, at whatever cost to people, the environment, and communities. People become mere puppets to the system, and end up crushed by costs, being alienated and dispossessed by an economy that deems than nothing more than a useless cog in a giant wheel!

Your are quite correct pop that the neoliberals and their code of 'greed is good' have marginalised different sections of the community. And I do agree with Dennis that the community is being undermined by this very process. This was rammed home to me a while ago when I came across some information on the Roy Morgan Research website.

Roy Morgan had done some background on youth unemployment, anxiety, depression and stress and uncovered some startling results. The study was based on young Aussies in the 18-24 years of age bracket and the outcomes gave an insight into the problems of those entering into the workforce. The results of the research can be found at:

One can only wonder at the results of similar surveys of say 12 to 18 year olds or as we have discussing older age groups say 50 to 65 years or 60 to 80 years or any age bracket for that matter. My greatest fear is what will the world be like in 20 or 30 years even if we make it through to then. Politicians for most part today are just stooges for/of neoliberal oligarchs as, as I have said previously, we slide into some form of modern day feudalism of robber land barons and penniless peasants.