A major new study comparing the health needs and service use of older people in the Republic of Ireland (ROI) with their counterparts in the North (N|) was launched at a Dublin conference held by the National Council on Ageing and Older People (NCAOP) and the Institute for Public Health in Ireland today.

The report ‘One Island-Two Systems’ – A Comparison of Health and Social Services Need and Use by Older People in the Republic and Northern Ireland' was compiled by the Healthy Ageing Research Programme (HARP) Team at RCSI, Trinity College Dublin (TCD), the Economic and Social Research Institute (ESRI), and Queen’s University of Belfast (QUB).

Over 2,000 people aged 65+ were extensively interviewed in their own homes throughout Ireland. Dispelling the view that older people are simply service users, it found most older people lived independent healthy lives with 12% of those surveyed being the primary caregiver for others, many of whom would themselves be other older people.

Participants in NI were more likely than those in the RoI to be caregivers (17% vs 8%) with a higher proportion of carers being women in both regions. NI had a higher proportion of men in caring roles than in the RoI.

According to the report’s lead author Professor Hannah McGee, Director of the Health Services Research Centre at the Department of Psychology, RCSI: "While we are inclined to think of older people as those needing care and who simply draw on the services and resources of the State, in fact they provide a high level of care to other (mainly older) people. This does not count their key roles in other areas such as care of grandchildren so in fact older people are also net contributors which is often not acknowledged."

Commenting on the study Dr Jane Wilde, Director of the Institute of Public Health in Ireland, said: "This report is a good example of all Ireland research involving several organisations. Significant differences exist in policy, structures and funding between the healthcare systems in the Republic of Ireland and Northern Ireland, yet many of the older people interviewed described similar challenges and opportunities across both jurisdictions. Many older people are living on a low income, have a disability and are living by themselves and because of these circumstances are finding themselves on the margins of society. We urge those involved in policy-making to consider the findings of the report and explore the development of approaches to make the experience of ageing on the island of Ireland a positive one."

The report also found that the majority of those surveyed expressed very strong preferences to live at home with outside support if needed rather than living in institutional care (89% in the RoI and 81% in NI). However, Professor McGee warned that the danger was that community based services were "not sufficiently developed" to provide for the desire of older people to stay at home on a longer term.

Significant north/south differences were found for a range of services, including use of home helps, meals on wheels, chiropody, and services from opticians, dentists and social workers. Of 15 services compared, nine were used by a higher proportion of older people in NI - "there seemed to be a better developed primary care service in the north than the south."

Satisfaction ratings for aspects of GP care, i.e. with the quality of information received, concerns taken seriously, and the availability of the GP were very high with almost 90% satisfaction in each area.

"The levels of hospitalisation were about equivalent as were the levels of GP care, but from the year 2000 to 2004 you do see a significant increase in the number of people over 70 attending GPs in the Republic, almost certainly linked to the free medical card for the over 70s which was introduced in 2001,"

Professor McGee stated: "Among the other key findings of the report were that NI participants were seen more quickly in A&E by a doctor than those in the RoI. 81% of NI vs 46% of RoI participants reported being seen by a doctor within an hour of arrival. However, hospitals in the Republic may have been seeing more complex cases as more of the RoI patients attending A&E were admitted to hospital."

Participants in the RoI rated their current health much more positively than those in NI. In parallel, and in support of their own ratings, those in NI were much more likely to report problems with routine activities of daily living such as walking, shopping and personal care – about one in three in the North had some difficulty and one in ten in the Republic. This was despite similar age profiles in the two groups. These north/south differences are significant and have not come to public attention before this study. The study concludes by reminding us that ensuring good health and social services for older people is in all our interests – we all want to live to a point where we can enjoy these services in our own old age.

Meanwhile a second report entitled 'Health and Social Services for Older People' (HeSSOP II) published by the National Council on Ageing and Older Peoplewas also launched at the NCAOP Conference. HeSSOP II provides valuable information for health and social service planners and providers on the health status and behaviour of older people living in the community. It builds on an earlier study published by the Council (HeSSOP I) in order to describe changes in health and mortality of older people, together with changes in their health, behaviour and service usage over a four year period. It does this in two ways: by repeating in 2004 a survey first conducted with different old people in 2000 and also by reinterviewing a group of over 300 people in 2004 who had already been interviewed in 2000. The study therefore incorporates the first longitudinal data on older people in this country.

The study was conducted in the old Eastern Regional Health Authority (ERHA) and the Western Health Board (WHB) areas. It provides some grounds for optimism: three quarters of the participants rated their health good or excellent in 2004, which was an improvement on 2000. There was a reduction in the numbers of older people smoking in the two areas. In addition over 70% in both boards had received the flu injection in Winter 2003/4. This was a notable increase from 2000 when 35% of ERHA and 46% of WHB participants were inoculated.

On the other hand, the study found that about one-in-10 participants had major difficulties in physical and psychosocial health (e.g. depression, loneliness or lower levels of support). Thus, while acknowledging that the majority of older people have good health, it is essential to focus adequate resources and care to improve the status of those who are most vulnerable.