In Praise of Idleness

Bertrand Russell 1872 -1970

Malcolm Futter NZ ASM Wellington November 2015

Aim to address the following questions: What is meant by age, ageing and ageism ? Why are age and retirement linked ? What makes retirement traumatic ? How can retirement become atraumatic ?

What is meant by age, ageing and ageism ?

Age - The length of time a person has lived or a thing has existed Ageing - The process of growing old Ageism - Prejudice or discrimination on the basis of a persons age

‘Ageism in society is very destructive’ - The Irish Times ‘Age discrimination is still seen as okay in the workplace’ - The Guardian ‘Ageism in the workplace hurts us all’ - The Age ‘Ageism: The Last acceptable form of discrimination’ - The Huffington Post

Physical deterioration ?

Cognitive deterioration ?

Stereotyping ageing can lead to ageism

Efforts of governmental and advocacy groups to counter ageism

“With one in four New Zealand workers likely to be aged 55 years and over by

2025, barriers to their employability and the proper utilisation of their skills need

to be explored and opportunities for improvements identified. One barrier is

age discrimination. Discrimination is the unequal treatment of equally qualified

workers. A range of researchers have found evidence of age discrimination in

hiring in New Zealand and overseas”

“What motivates this paper is not the existence of age discrimination against

older workers, but its persistence. Why does age discrimination against older

workers persist despite competition? Why do employers, operating in competitive

markets, seeking profits and wanting to reduce costs, choose to not employ well-

qualified older workers on merit and instead hire younger applicants? “

San Jose Mercury News

Lisa M. Krieger June 2015

Stanford doctors fight age-related test of fitness to

practice

A small but mighty cadre of senior Stanford physicians is protesting

the growing national trend to test aging doctors for their fitness to

practice medicine, saying there is no evidence that age impairs their

clinical abilities.

A new report by an American Medical Association council, released

Monday, urges doctors to assess elder colleagues' competencies, a

recommendation that echoes Stanford Health Center's three-year-old

policy of evaluating all physicians over age 75.

Meanwhile in the U S of A……

“The guidelines in this document are designated by the author as Level C, "the consensus of expert opinion," under the American Academy of Family Physicians' rating system for levels of evidence used, as described in its journal, American Family Physician.” 2015

……with rationale, methodology and legal advice !

Why are age and retirement linked ?

How well founded is the expert opinion and is there an element of ageism?

• ‘Common knowledge’

• Behavioural/ neurocognitive research

• Outcome analysis

• Economic

‘Common knowledge’ The way retirement is viewed:

Something for the old and less active………

At the age of 68 with a speed of 183mph Burt Munro set a world speed record for under 1000cc motorbikes. The record still stands today……

0 20 40 60 years

fluid

memory

crystallised

memory

A young retired person’s guide to cognitive function

Behavioural/ neurocognitive research

• age-related cognitive decline begins relatively early in adulthood,

• may not be detected in longitudinal comparisons

• not all aspects of cognitive functioning exhibit early age-related decline

• tests of accumulated knowledge consistently increase until at least age 60y.

Implications for commencing testing at specific age if onset and rate of decline is variable

Proceedings National Academy of Science, 2012 , 109.3, 770 -774

4 genes associated with general (fluid) cognitive function

Relationships between age and reasoning Models of diagnostic reasoning Age related changes in cognitive processing Can experience counteract the effects of ageing ?

“….the work described in this paper does not support ageist discrimination. In fact, one of the more robust findings in aging research is that the variability across the scores individuals receive tends to increase with age, thereby suggesting that strong individual differences exist. Although the average performance tends to be lower, many older individuals perform at levels equal to (or above) those of their younger colleagues. As such, decisions regarding continuing competence should be made at the individual level rather than instituting mandatory retirement policies….”

Methods

• Billing data for BC, Quebec, Ontario from Jan. 1, 1993 to Dec. 31, 2002.

• Canadian Medical Protective Association data from Jan. 1, 1993, and Dec. 31, 2002, in

which anesthesiologist at least partial responsibility for ‘event’

Results (with less than 51 age group taken as reference category)

• Litigation rates for 51–64 age group was 1.14 (95% CI: 0.99 –1.32)

• Litigation rates for 65 and older age group was 1.50 (95% CI: 1.14 –1.97)

• Patient Disability for 51–64 group 1.31 (95% CI: 0.95–1.80)

• Patient disability for 65 and older group 1.94 (95% CI: 1.41–2.67)

Unable to adjust for patient related factors such as socio economic status, co-morbidity etc

only for case complexity, probable case numbers

A reply from an aged anesthesiologist….

“….If we assume that the 65-yr-old anesthesiologists entered training at age 25, they would have begun residency between 1953 and 1962, just before anesthesia programs began to attract the best and brightest, as they do today .... in 1946 John Lundy noted ‘There was a tendency for only those physicians who were incompetent in general practice or in other branches to limit themselves to the practice of anesthesia’ ....perhaps a confounding factor was that the older anesthesiologists were less competent to begin with.” E Eger, UCSF.

¬60 studies relating length of time in practice or physician age to:

• Knowledge • Adherence to Standards of Appropriate Diagnosis, Screening, and Prevention • Therapy • Health Care Outcomes

Influence of clinical knowledge, organizational context, and practice style on transfusion decision making. Implications for practice change strategies.

Salem-Schatz SR1, Avorn J, Soumerai SB. JAMA. 1990 Jul 25;264(4):476-83 • face-to-face survey of 76 surgeons, and 46 anesthesiologists in three hospitals.

(~ 20 ‘attending’ anesthesiologists of whom ~8 in practice >20 years).

• widespread deficiencies in physicians' knowledge of risks and indications.

• attending physicians routinely had lower knowledge scores than did residents, yet they exhibited more confidence in their knowledge.

Reported by Choudhry et al as showing a “strong inverse association between years in practice and knowledge of transfusion risks and indications (P= 0.0001)”

683 physicians over 10 years referred to Centre for Personalised Education for Physicians

• Likelihood of safe v. unsafe assessment :

• Older practitioners - OR* = 1.07; P < .001 * odds ratio

• Board Certification - OR = 0.40; P = .003

• Solo practice - OR = 2.15; P = .037

• Practice scope matched training - OR = 0.29; P = .023

• Physicians with current or previous board action - OR = 2.47; P = .003

“A competence review for physicians over a certain age would be prima facie age discrimination” under part 1 of the Human Rights Act 1993 (New Zealand Human Rights Commission, May 14, 2002).

First, assessing the performance of physicians about whom concerns have been expressed cannot alone identify all poor performers, but regularly assessing the performance of all physicians in all domains of competence is impractical.

Second, while high-risk groups can be recognized from personal and practice characteristics, privacy, human rights, and other constraints may effectively prevent their identification and assessment.

Third, screening tools for identification of poorly performing physicians are being evaluated, but there is as yet no single practical test that can accurately identify physicians whose performance is in need of more thorough assessment.

What makes retirement traumatic ? Involuntary - competence, health Social isolation Loss of status Financial concerns Boredom

Avoiding competency issues

1. Smile at everyone

2. Listen to what people have to say

3. Resist the urge to say what you think

4. Keep paying for enrolment in ANZCA’s CPD programme

Avoiding health issues

5. Stay current with articles in Women’s Weekly, Listener etc

6. Undertake physical activity, preferably as part of a group ( see 9).

7. Find a GP who knows more than you do

8. Read Russell

Making Retirement Atraumatic with the MEF20 Plan

“One of the symptoms of approaching nervous breakdown is the belief that one's work is terribly important, and that to take a holiday would bring all kinds of disaster. If I were a medical man, I should prescribe a holiday to any patient who considered his work important.” Conquest of Happiness 1930

Avoiding Social Isolation

9. Be sociable

10. Find a group activity

11. Get out and meet people (see 14)

Avoiding Loss of Status

12. Get elected chairman/president /captain of something (see 9)

13. Explain to husband/wife that now your home you’re in charge

14. Buy a dog (see 11) not a cat.

For details phone 027 518 8883

Rent a Van Go places, meet people, save money….

…..before proceeding to the next part of the talk you

must acknowledge you are waiving all rights you

might have under the Financial Advisers Act 2008

and Financial Service Providers (Registration and

Dispute Resolution) Act 2008

Avoiding financial concerns 15. Read more Russell

16. Cultivate generous friends (see 11)

17. Liquidate assets

Avoiding a long and boring retirement

18. Travel

19. Develop habit of having a nap, daydreaming, meditating etc.

20. Become adventurous

“A life without adventure is likely to be unsatisfying, but a life in which adventure is allowed to take whatever form it will is sure to be short”

The End