At 70 Dr Doug Wilson isn’t curmudgeonly when he poses some curly questions on the future for the elderly.

His conversation is peppered with humour and plenty of statistics and research findings.

Named Ryman Healthcare Senior New Zealander of the Year Te Mātāpuputu o te Tau in late March – in an interview on a warm autumn morning, the medical academic and author, fresh from recording a podcast, is barefoot and well-dressed.

He talks at ease from a large couch at his Taupō home, joking later that we should take the photo outside before he is swallowed by the cushions.

As his podcast has been on the Covid-19 vaccine for those in aged care facilities, I ask if this was one of the challenges he was thinking of in his award acceptance speech.

(In a two-minute thank you at the glitzy function in Auckland, Wilson said it was inevitable individuals would face challenges and have to adapt if they couldn’t get past them.)

But Wilson, heavily involved in HIV research while in the States during the early years of that epidemic, says an issue like Covid-19 was always going to come along.

“I think older people face all sorts of obstacles which we haven’t quite defined in a sort of classic action sense. If you’re living 15-20 years older than your grandparents did and the age of super comes in at 65 – the old age pension when we first got it came in at 65 and that was 1898 – I don’t think any funding authority had quite planned to have hundreds of thousands of people living 20 years extra.”

Figures suggest New Zealand with a 2019 super bill of $14.5 billion, increasing by more than $1b each year, will be paying out over $100m a day by 2050.

Wilson admits when he saw the figures he thought there must be a nought wrong somewhere.

“There’s the money side of it and the second part of it is, as you get older you’re more susceptible to some diseases: cancer, diabetes, heart attacks, stroke, dementia.”

When Wilson graduated, dementia cases were rare as few people lived past their early 70s but over the age of 65 the rate of dementia doubles every five years. For those in their 90s about 20 per cent of the population show early signs.

While some research, such as a Finnish study, shows a suite of interventions could benefit mental function in 70-year-olds, there is no adequate treatment for dementia, at all, he says – and certainly no pill.

The holy grail for researchers is to find something that slows it down or reverses it, yet 250 long term studies have all failed.

“We do for the other things. Heart attacks way down on what they used to be, stroke way down, cancer we are probably really good at dealing with half the cancers that are out there that we didn’t have treatments for before. Huge, huge gain. Disability, well we’ll replace your joint, never could before. People’s lives now are transformed compared to what they were, not as bad, not as tough, but because they’re living longer, the tough issues still remain.”

People now are older for longer, and may spend a significant period in 24 hour care.

“And you’ve just eked out, chewed up, all the bonus options banked away.

“Then there’s housing on top of that… How do we house one and a half million people over 65 in 30 years. How do you house them? I don’t think we have even got to grips with it. And if you think of climate change and the impact that we can make in New Zealand it’s relatively modest, but we are staring in the face of quite a financial hurdle.”

Not to mention who will support a population top heavy with elderly.

“In say 15 years from now, people in my age group, the over 80s, that population will increase by 137 per cent. Fourteen and under 7.5 per cent. It’s happening in Japan and Korea, countries where the replacement fertility rate has tumbled, reaching the stage where the whole population is shrinking.”

Retaining one’s health is one of the most important measures in avoiding other travails that come with age, he says.

“Old folk trudge along and see the general practitioner who has got 15 minutes to see this or that, and it’s quite common for older people to present with an illness which is different from how the presentation might suggest.

“And that’s normal but that’s part of the fact that it’s rather harder to manage older people than it is to manage younger people. The burden on the district health boards is substantial because people go into care and if they don’t have any assets then it becomes the responsibility of the DHB.”

But, on the positive side, he says “you can have a fantastic few years as an older person if you’ve got your wherewithal.”

He recommends walking, at least, for its physical and temporary mental kick, “those people who are active exercisers – and it doesn’t need to be killing exercise but some exercise – reduce the rate at which their body may decline and reduce the rate at which their mental function declines...

“Really with that one particular intervention, if you combine that with stimulating your brain, writing stuff, reading stuff – even read the Taupō Times – (which I laugh might stimulate anger, though readers can go through with a highlighter and mark mistakes) and then you’ve got relationships which are pretty important... Don’t eat to excess, watch your weight, the standard sort of boring stuff, all far more important now if you hit your 60s or 70s and 80s. These quite banal recommendations of healthy living become more important for you because once you decline it’s very hard to go back up again.”

But back to the malaise du jour – Covid-19. Wilson sees some parallels in how the HIV/AIDS epidemic was eventually tamed.

“Lots of people in South Africa are still infected but these days we’ve now got medications that work on that in ways that are proving very difficult to get medications to work for Covid-19. It took a long time and there’s still no vaccine for HIV...

“With Covid you’ve got to bring it under control. Because if it’s out of control you can see how lethal it is to people in rows in intensive care unable to breathe because they can’t get enough oxygen through.”

The United Kingdom had demonstrated a substantial turnaround, he felt.

“The UK going back to early February, late January, I think, had its biggest day in Covid-19 deaths. That was about 1600 in a day, yesterday was 20, and they have vaccinated over 50 per cent of the population.”

They messed up the first stage, but then instituted a plan without too many priority groups, he says.

“They said we will deal with it by age almost entirely. Start with the over 80s, move down to the 70s, to the 60s, and for people who have other coexisting illnesses who might be considered a separate priority, they will be captured in each of these tiers anyway.

“To split up the delivery of the vaccine so you’ve got all these mini-groups provides a logistic log-jam.”

He accepts though that health authorities here could argue we’re in a different situation, without the impetus of new community cases appearing.

“And that’s true, but it doesn’t take much to escape. If it’s a new variant that escapes that’s worse than before then suddenly you can have 100, 200, 500, exponential growth. Two thousand cases over the course of a couple of weeks. It could happen and then we’re in strife.

“If you want to open your bubble with other countries then their strife becomes your strife. You can’t stick everybody in quarantine because they showed a different version of the virus. It just becomes a complicated deal.”

But he welcomed the naming of epidemiologist Professor Sir David Skegg to head a group of scientists to advise government officials on crucial Covid-19 decisions – including when it will be safe to open the borders.

“I am sure we will get there.”

Credit: Stuff.co.nz