Issues

Ageing
Our understanding of ageing has been undermined by the failure to study the ageing process in anyone but the old. The lack of attention to income, sex, race, social class and type of work and their contribution to general health has directed attention away from features of the social structure that may reject or impoverish the lives of old people. There has been a tendency to individualise problems rather than focus on what makes old age a difficult experience of life . The association of age with disease and the assumption that medical services can best address problems of old people ignores the majority of old people who are healthy and the holistic needs of old people .

Stereotypes and attitudes
Attitudes bear upon behaviour. Society's view of old people derives from a number of sources such as its cultural heritage, decisions about allocation of work and social attitudes of worth . Negative stereotypes are coloured by the association of decline in faculties and an increase in disability that is true of the ageing process but not confined to the elderly, nor characteristic of all old people . They ignore the variety of experiences of being old and the positive achievements of cohorts of people who are living longer lives .

Intergenerational equity
The deployment of resources raises questions of intergenerational equity . The ratio of dependants to the working population is growing with the balance among dependants weighted to people over 65, who will constitute 18% of the population in 2001 . Old people are positively discriminated for with free prescriptions, as are some other groups in society and old people are major consumers of care services. They occupy two-thirds of acute beds and they consumed 47% of local authority social services expenditure in 1997 and 42% of NHS expenditure in 1999 , though it is people over 85 who make most use of these services.

Equity
It is not possible to say whether the allocation of resources in health and social care is influenced by considerations of age and negative stereotypes of old people. However, allegations of discrimination suggest that it is important to examine stereotypes, to examine attitudes behind discriminatory activity and how resources are allocated. The right to work, access to services and to representation raises moral issues and rights of citizenship. Equality is part of our morality and 'applies as much in the face of discrimination on the basis of chronological age or life expectancy as it does to discrimination on the basis of gender, race and other arbitrary features' (Harris, 1998: 63) . An integrated policy addressing the broad needs of an ageing society has been called for .

A number of studies at both macro and micro levels from primary sources to general reviews suggest evidence for direct and indirect discrimination .

Health Care Systems: indirect discrimination?
Structural aspects of the systems delivering care can make the experience of service difficult for old people. Is this a form of indirect discrimination?

Chronic illness. The health system is biased to acute and curative services. It gives less attention to degenerative and chronic illnesses and the promotion of health and well-being and in particular, the benefits to be derived from postponing the onset of morbidity. The absence of a clear strategy to reduce morbidity, especially amongst old people, is criticised in Debate of the Age and the Royal Commission on Long Term Care . The Commission noted that even with a large increase in numbers, reducing chronic illness and disability would be a major case for reducing the need for long term care.

Training. Stereotypical attitudes towards old people see them as requiring less skilled help. Involved professionals such as nurses do not have specialist training and only about 40% of GP's get in depth experience of geriatric medicine .

Resources. There is a shortage of appropriate resources. The NHS reduced its supply of geriatric care beds in the 1980's as part of government policy to develop community care in place of institutional services. The NHS did not invest the freed revenue in a commensurate development of community care for old people , so narrowing its role to acute care for the elderly which the Audit Commission observed to 'represent major shifts in policy that have never been debated or agreed' . Addressing this, the Department of Health issued guidelines requiring health authorities to reinvest and, with social service departments, to develop local criteria and policies for NHS funded care. However, few additional resources have been made available and there is still little intermediate or rehabilitative care . Old people who need care that is not available in the community, have to enter residential or nursing homes where they are subject to charges using a means-test. An estimated 28% of such residents are self-payers.

Costs. Health care is not always free. The Royal Commission on Long Term Care argued for all nursing and personal care costs to be met by the state on grounds that as requirements for personal care went beyond an individual's control, they should be free and treated as other health care needs. The government has decided that only nursing costs will be so provided . Professionals have challenged this decision as unworkable .

Integration. The complexity of service arrangements, deriving from two parallel systems of care, health care which is free and personal social services, for which charges are made, adds to difficulties encountered by old people. This has lead to calls for a more integrated service from many including the House of Commons Health Committee . The call for integration extends to addressing discrepancies within health care. The government's National Service Framework for older people is to set standards and these should not operate in isolation.

Direct discrimination
The BMA has stated that patients should not be denied medical diagnosis and treatment on the basis of age but both the Royal College of Physicians and the Medical Research Council have acknowledged that age discrimination in the NHS is a problem .

Rationing. Discrimination is part of the wider context of health care rationing and operates through cost measures, waiting lists and eligibility criteria. At present, 'decisions take place covertly, and are often the result of judgements by individual clinicians' and are made locally rather than nationally with variation between localities . The Kings Fund Rationing Agenda Group and Debate of the Age have argued the government should accept responsibility for making rationing decisions explicit and there is scope for the National Institute for Clinical Excellence to expand its role here .

Evidence for explicit discrimination include:
· TRIALS. People over 70 are excluded from clinical trials although half of new malignancies occur in such people and the drugs developed may not be the best for their age group .
· CHECKS and SCREENING. Women over 65 are excluded from regular breast cancer screening although 63% of deaths occur in women aged 65+. Older women are not recommended for regular follow-up for cervical screening, despite evidence of benefits beyond 65 for cervical cancer and up to age 74 for breast cancer .
25% of women are at risk of osteoporosis but not screened as a high risk group
· TREATMENT. Rates of potentially life saving and life enhancing investigations and interventions in cardiology decline as patients get older. One fifth of coronary care units operate age-related admission policies and two fifths have age restrictions for giving clot-busting drug therapy .
Incidence of kidney disease rises with age but older people are less likely to receive renal replacement therapy .
· CARE. Up to 24% of care home residents may be on anti-psychotics and in up to 88% of cases, the use of neuroleptics would be inappropriate by US standards .
A report from the Health Advisory Service 2000 revealed serious issues of discrimination and lack of care on hospital wards .
· REFERRALS. 10% of GPs have not referred in the past because they know of age-barriers for treatment/services and 16% sometimes would not refer suspecting patients would not get treated because of their age .

Neither the Department of Health nor the Health Service Ombudsman collects data about the denial of service on grounds of age. Age Concern suggest the government should carry out its own investigation (Gilchrist, 1999:36). One basis for rationing by age is the fair innings argument. Alan Williams Quality Adjusted Life Years (QALYs) take account of years completed (innings) to calculate the number of years of better quality of life for a given treatment. Critics maintain it is inherently discriminatory as older people have less time to live whatever their benefits from treatment and any shortage of resources could be used to exert pressure to bring the age cut-off point forward in time. Grimley Evans points out that not performing an operation does not necessarily save money because other costs well in excess of an operation can be incurred. More significantly, such approaches are unethical and represent exploitation of the weak on grounds of lower social worth .

Social Care
Systems: indirect discrimination?
Many of the ways old people are denied the means to exercise their citizenship rights and responsibilities apply equally to others, such as inadequate information, inaccessibility of services and inability of staff to communicate appropriately .

Training. The lack of heavy statutory obligations relating to care for old people has left it with low status . Most such workers are untrained and without qualifications . Literature suggests there is indirect discrimination in training assumptions and resource allocation that is sometimes made explicit in language and behaviour (of which the worst kind is manifested in abuse ).

Service variability. If a need is identified, there is no automatic right to social service support. Provision varies across local authorities in eligibility criteria, range, quality and whether or not charges are imposed. Recent rationing decisions have focussed on helping those with greatest need, meaning those with lower levels of need lose out . There has been an increase in the percentage of people using private help .

Resources. Old people are often described as passive recipients of a fixed and inflexible service which incorporates modular packages that limit rather than encourage self-management and development . The risk of dementia increases with age but it is thought that policy changes have adversely affected the help available to old people with impaired intellectual ability, mental illness and dementia . Inadequate services and poor co-operation between health and social services diminishes a person's capacity to live independently in the community and increase the likelihood of hospital admission .

Goals. The 1990 NHS and Community Care Act created a quasi market and local authorities have been withdrawing as providers of services. In the new climate, pressures for efficiency, effectiveness and cost-saving are said to make the voice and interests of old people inaudible in a process that is meant to be user centred . For example, costs have precluded developments towards a much called for multi-disciplinary approach to community and residential care .

Participation and representation. The Chronically Sick and Disabled Persons Act (1970) and the 1986 Disabled Persons Act gave the needs of old people more recognition but rights enshrined in these acts have not been fully implemented, including old people's rights to representation. Advocacy has no legal status so there is no funding . By contrast, advocacy forms an important part of provision in the USA, Australia and Canada. The 1990 NHS and Community Care Act required local authorities to assess the care needs of old people and may have put their needs more firmly onto the agenda. The government's recent programme of activities towards Better Government for Older People has demonstrated that old people can be successfully involved in local decision making and the local authorities involved have responded positively to this contact and exchange .

Informal care. One third of informal carers are old . Family care for old people living in the community in Britain represents between two and three times the input of the formal sector and needs support. Whether proposals in the government's White Paper Caring about Carers will be enough given the pressure on resources is open to question.

Direct discrimination

Costs. One third of local authorities have charging polices for services which are used predominantly by old people, such as home helps. Above a certain minimum income, old people also have to finance long-term care outside nursing costs from their life-savings and/or by relinquishing their homes .

State Benefits. The state benefit system treats chronological age differently and does not recognise that the majority of people with disabilities are over retirement age; 76% of the 6 million people with a disability were over 60 in 1988, nearly 20% of those with disabilities were over 80 . A number of disablement benefits (such as Long Term Incapacity Benefit and Disability Living Allowance) cannot be claimed when an individual reaches a certain age, implying that disability is regarded as a normal part of old age

Work

Social inclusion. Employment is a key factor and the restricted access of old people to employment and their low incomes is a feature of most European societies . Britain has pushed alternative private and occupational pension schemes more than other countries and her basic state pension is considerably lower (having been linked to prices rather than income levels since 1982) than those provided by most other European countries . Just under 1 in 5 pensioners receive Income Supplement and 19% of pensioners are entitled to it but do not claim . There is a polarisation in society and a polarisation within elderly cohorts as inequalities of working life persist into old age . In addition there is gender inequality as 3.1 million of the 3.5 million who do not qualify for the full basic pension are women (Jowell, 2000).

Activity rates. A significant drop in activity rates has taken place for all age groups over 50 years including a decrease in the significance of paid work after retirement. In 1951, 31% of men over 65 were in paid work, by 1991 this figure was below 10% . There has been a dramatic fall in activity rates for people 50 -64 years (those below retirement age) across industrialised countries except Sweden and Japan and this cannot be explained solely by maturation and widening of retirement pensions.

Costs. While some workers have retired voluntarily, most people leaving work between 50 and the state pension age, do not appear to have done so voluntarily and almost half of them receive most of their income in state benefits . Exit from work no longer corresponds with entry to pension rights but a period of insecurity . In an attempt to address the consequent high costs, some countries have raised the retirement age, others have extended the years of contribution for state pensions .

Unsustainable. In periods of recession and high unemployment, employers have traditionally replaced older with younger workers . This pattern of substitution no longer serves the economy or social interest but is proving difficult to reverse as older workers are low priority for training and retraining . Current patterns of work distribution exclude large sectors of society and if maintained, will lead to a shortage of skilled labour because in 2010, 40% of the labour force will be 40+ .

Responses. A number of voluntary organisations represent the interests of those who would challenge these trends, such as Third Age Employment, CAADE (Campaign Against Age Discrimination, LEAD (Lobby to End Age Discrimination) and the Employers Forum on Ageing. Eurobarometer surveys indicate that a high proportion of EU citizens believe that older workers are discriminated against . To address age discrimination in the workplace, the Labour government has opted for a Voluntary Code of Practice with recommendations for good practice in recruitment, selection, promotion, training and development and case studies for guidance. The code's legal status is not clear as it does not have the status of codes for sex, race and disability discrimination; age discrimination is generally not unlawful. The government has recently endorsed the case for a further review.

Options

Europe. The introduction of Article 13 of the Treaty of Rome gives the European Union the power to introduce directives (EC 1999d) to prohibit discrimination on a number of grounds including age. These directives are a statement of intent without legal force. There are also policy statements which encourage governments to review policies that encourage early exit from the labour force .

Britain. Although legislation against age discrimination is rare it carries symbolic value and a survey of major British employers shows a majority favour it . It has had a positive impact in the USA but as part of a wider package of changes that addressed aspects of the benefit system and pension entitlements which encouraged early retirement . It is not yet clear whether article 14 of the Human Rights Legislation will have created an opportunity to challenge discrimination on grounds of age. The Debate of the Age has argued the need for a general policy of 'age-neutrality' . Its authors go further to advance the case for a radical revision of the way society is organised with more attention given to investing in public resources and the infrastructure, such as transport and sharing what work there is more equitably. Such changes would make most impact to the life experience of old people .

References

Vincent J.A. (1999), Politics, power and old age, Buckingham, Open University Press
Ginn, Jay and Arber, Sara (1998), 'Gender and older age'. In Bernard and Phillips (eds.)

Evandrou, M. (1998), 'Great expectations: social policy and the new millennium elders'. In Bernard M. and Phillips J, eds. (1998), The Social Policy of Old Age: moving into the 21st century, Centre for Policy on Ageing. Harding T. (1995), 'Questions of tomorrow', Community Care, 30.11.95, p.21

Hughes B. (1995), Older people and Community Care, Buckingham, Open University Press.
Biggs, Simon (1993), Understanding Ageing: images, attitudes and professional practice, Buckingham, Open University Press

Bland R. ed. (1996), Developing services for older people and their families, Jessical Kingsley,
London. Bounds, J. (1993), 'Ageism - its effects on services', Elders: the Journal of
Care and Practice, 2(3) pp.29-36. Biggs, S. (1993), Understanding Ageing: images,
attitudes and professional practice, Buckingham, Open University Press. Bytheway B. (1995), Ageism, Buckingham, Open University Press. Scrutton S. (1988), 'Medicalising the care of old people', Social Work Today, 23.6.88, pp.14-15

Simey, M. (1998), 'The politics of ageing'. In Bernard and Phillips, eds.. Biggs, Simon (1993), op cit.

Johnson, M. (1997), 'Generational Equity and Re-formulation of Retirement', Scandavian Journal of Social Welfare. Vincent, John A (1999), Politics, Power and Old Age, Buckingham, Open University Press. Hugman, R. (1994), Ageing and the Care of Older People in Europe, Centre for Policy on Ageing, Macmillan

Scales J. (1999) in Future Work and Lifestyles, Debate of the Age (1999d), Age Concern.
Pahl R. (1999), 'Work and lifestyles: dilemmas of the age' in Future Work and Lifestyles, Debate of the Age, Age Concern

Milburn A. (1999), Reinventing Healthcare - A Modern NHS versus a Private Alternative,
Address 20/1/99 at London School of Economics

Audit Commission for Local Authorities and the National Health Service, (1997), The Coming of Age: improving care services for older people, Audit Commission Publications

Gilchrist quoting Government Expenditure Plans 1996/7-1998/9, DoH, Department Report Cm 3212, HMSO 1996.

Harris J. (1998), 'Are moral claims age-relative?', in Increasing longevity: medical, social and political implications, ed. R. Tallis, Royal College of Physicians of London

Bernard, M. and Phillips J. (1998) 'Social Policy and the challenge of old age', in Bernard and Phillips (eds.). Debate of the Age (1999a), Values and Attitudes in an Ageing Society. The Millenium papers, Age Concern England

Biggs, Simon (1993), op cit. Bytheway B. (1995), op cit. Midwinter E. (1992), Citizenship: from ageism to participation, Carnegie United Kingdom/Centre for Policy on Ageing, Dunfermline/London. Willis, Martin (1993), Older People and Equal Citizenship: an agenda for Local Authorities. Occasional paper written for the Local Government Management Board, LGMB.

Tinker A. (1994), 'Elderly people and discrimination', Journal of Interprofessional Care, 8 (2).
Banerjee A.(1996), 'Lack of equity threatens quality' in Equity in Healthcare for Older People, Age Concern

Debate of the Age (1999c), The Future of Health and Care of Older People, Millenium Papers, Chair, Rabbi Julia Neuberger, Age Concern

Royal Commission on Long Term Care, (1999), With Respect to Old Age: Long Term Care -
Rights and Responsibilities, Cm 4192, London, HMSO.

Debate of the Age (1999b), Health and Care. Millenium Papers: Interim Report. Chair: Rabbi Julia Neuberger, Age Concern England

Courtney M. (1996), 'Last Among Equals', Nursing Times, 92, 45,47

Audit Commission for Local Authorities and the National Health Service (1997), The Coming of Age: improving care services for older people, Audit Commission Publications, p.12

Department of Health (1995), NHS Responsibilities for Meeting Continuing Health Care Needs, HSG (95) 8.

Debate of the Age (1999b), Health and Care. Millenium Papers: Interim Report. Chair: Rabbi
Julia Neuberger, Age Concern England

Carlisle D. (1996), 'The View from the Sharp End', Nursing Times, 92, 26-30

Department of Health (1999), Royal Commission on Long Term Care, With Respect to Old Age: Long Term Care - Rights and Responsibilities, Cm 4192, London, HMSO

Department of Health (2000), The NHS Plan: the Government's response to the Royal Commission on Long Term Care, Cm4818-II, London, HMSO

John Carvel, Guardian 1st September, 2000

Age Concern (1998b), Boundaries and barriers in services for older people. Submission by Age Concern to the Royal Commission on Long Term Care for the Elderly. Ref. 1798, Age Concern England. Audit Commission for Local Authorities and the National Health Service (1997), The Coming of Age: improving care services for older people, Audit Commission Publications. Debate of the Age (1999c), The Future of Health and Care of Older People. Chair: Rabbi Julia Neuberger, Age Concern England

House of Commons Health Committee (1999), The Relationship between Health and Social Services, ???
British Medical Association (1993), 'Rationing and allocation of health care resources', in Medical Ethics Today, BMJ, London, 199-316

Medical Research Council (1994), The Health of the UK's Elderly People, MRC. Royal College of Physicians (1994), Ensuring equity and quality of care for elderly people, RCP.

Milburn A. (1999), Reinventing Healthcare - A Modern NHS versus a Private Alternative, Address 20/1/99 at London School of Economics

Debate of the Age (1999c), The Future of Health and Care of Older People, Millenium Papers,
Chair, Rabbi Julia Neuberger, Age Concern, p.38

Malone N. and Rycroft-Malone J. (1998), 'Equity and rationing in the NHS: past to present', Journal of Nursing Management, 6 (6), pp.325-332

Debate of the Age (1999c), The Future of Health and Care of Older People, Millenium Papers, Chair, Rabbi Julia Neuberger, Age Concern

Fentiman I. Tirelli et al (1990), 'Cancer in the Elderly: why so badly treated?' Lancet, April 28 pp.1020-
1022

Medical Research Council (1994), The Health of the UK's Elderly People, MRC

Henwood M. (1990), 'No sense of urgency: age discrimination in healthcare', in (eds.) Age the Unrecognised Discrimination, Age Concern England

Dudley and Burns, 'The influence of age on policies for admission and thrombolysis in coronary care units in the UK', Age and Ageing, 1992 (21) pp.95-98. Bowling A. (1999), 'Ageism in cardiology', BMJ, 319, pp.1353-1355

Department of Health, (1996), Renal Review, London, HMSO

Lester M. Warner J., (1998),'Anti-psychotic drugs: their use and misuse', Journal of Dementia Care, January/February 1998

Health Advisory Service (1998), Not because they are old, Health Advisory Service 2000, quoted in Gilchrist, 1999.

Survey commissioned by Age Concern and conducted by the National Opinion Poll, May 2000

Gilchrist C. (1999), Turning your back on us: older people and the NHS, Age Concern

Williams A.(1997), 'Intergenerational equity: an exploration of the 'fair innings' argument', Health Economics, 6 (2), pp.117-132. Williams A (1997), 'Rationing health care by age: the case for', British Medical Journal, 314, 15th March, pp.820-5

Grimley Evans (1997) 'Rationing health care by age: the case against', British Medical Journal, 314, 15th March, pp. 820-5

Willis, Martin (1993) op cit.

Ogg J., et al, (1998), 'Professional responses to the challenge of old age'. In Bernard and
Phillips (eds.). Walker A. and Walker C. (1998), 'Age or disability? Age-based disparities in service
provision for older people with intellectual disabilities in Great Britain', Journal of Intellectual and Developmental Disability, 23 (1), March, pp.25-39

Johnson M.L. et al (1999), Managers in long-term care; their quality and qualities, The Policy Press and Joseph Rowntree Foundation. Debate of the Age (1999b), Health and Care. Millenium Papers: Interim Report. Chair: Rabbi Julia Neuberger, Age Concern England

McCreadie C. (1996), Elder abuse: update on research, Age Concern Institute of Gerontology, Kings College London

NACAB, National Association of Citizens Advice Bureau (1997), Rationing Community Care, NACAB

Office for National Statistics (1998), Informal Carers, Rolands O. Independent survey carried out as part of GHS, London, HMSO

Myers F. and MacDonald C. (1996),'I was given options not choices: Involving Older Users
and Cares in Assessment and Care Planning' in Bland R. ed. (1996), Developing services for older people and their families, Jessical Kingsley, London. Marshall M. and Rowlings C. (1998), 'Facing our Futures: Discrimination in Later Life'. In Lesnick B., Countering Discrimination in Social Work, Aldershot, Arena. Ogg J., et al, (1998), op cit.

Adams T. (1996), 'The case for breaking through ageism in mental health care', Nursing Times 20.3.96, pp.46-7. Walker A. and Walker C. (1998), 'Age or disability? Age-based disparities in service provision for older people with intellectual disabilities in Great Britain', Journal of Intellectual and Developmental Disability, 23 (1), March, pp.25-39

Audit Commission (2000b), Fully Equipped - The provision of equipment to older or disabled people by NHS trusts and social services departments in England and Wales, Audit Commission Publications, March

Age Concern (1998b), Boundaries and barriers in services for older people. Submission by Age Concern to the Royal Commission on Long Term Care for the Elderly. Ref. 1798, Age Concern England

Age Concern (1996), Stuck on the waiting list: older people and equipment for independent living, Age Concern England. Audit Commission (2000a), Forget Me Not: Mental Health Service for Older People, Audit Commission Publications, January

Ogg J., et al, (1998), op cit.

Association of Directors of Social Services, 1994, Continuing Care: continuing concern
Social Services Inspectorate (1996), The Key to Independence: social rehabilitation schemes for older people

Dunning A. (1998), 'Advocacy, empowerment and older people' in Bernard and Phillips (eds.). Simey M. (1998), 'The politics of ageing' in Bernard and Phillips, (eds.)

Schreeve M. (1999), Director, Making it Happen. Report of the first year of the Better Government for Older People programme, 1998-1999

Cabinet Office, All our futures. Report of the Steering Committee of the Better Government for
Older People Programme, June 2000

Evandrou M. (1998), 'Great Expectations: social policy and the new millenium elders' in Bernard and Phillips (eds.)

Department of Health (1999), Caring about Carers, White Paper, London, HMSO

Department of Health (2000), The NHS Plan: the Government's response to the Royal Commission on Long Term Care, Cm4818-II, London, HMSO

Office for National Statistics (1998), Informal Carers, Rolands O. Independent survey carried out as part of General Houseshold Survey, London, HMSO

Scales J. (1999) in Future Work and Lifestyles, Debate of the Age (1999d), Age Concern
Pahl R. (1999), 'Work and lifestyles: dilemmas of the age' in Future Work and Lifestyles, Debate of the Age, 1999d, Age Concern. Young M. and Schuller T. (1991), Life after Work, Harper Collins

Hugman, R. (1994), Ageing and the Care of Older People in Europe, Centre for Policy on Ageing, Macmillan

Walker A. (1990), 'The Benefits of Old Age', in Age Concern, The Unrecognised Discrimination, Age Concern England

Department of Social Security (2000), Opportunity for All: 2000, London, HMSO

Scrutton (1990), 'The foundation of age of age discrimination' in Age Concern, The Unrecognised Discrimination, Age Concern England. Walker A, Guillemand and Alber (1991), The Impact of Social and Economic Policies on Older People in the European Community, (EC Observatory on Older People), European Commission. Falkingham J. (1998), 'Financial (In)security in later life' in Bernard and Phillips (eds.)

Phillipson C. (1998), Changing work and retirement: older workers, discrimination and the labour market' in Bernard and Phillips, (eds.)

Walker A, Guillemand and Alber (1991) op cit.

Cabinet Office (2000), Winning the Generation Game, A PIU Report, April 2000.

Phillipson C. (1998) op cit.

Walker A, Guillemand and Alber (1991) op cit
Walker A. (1990), 'The Benefits of Old Age', in Age Concern, The Unrecognised Discrimination, Age Concern England

Walker A. and Maltby T. (1997) op cit.; Phillipson C. (1998) op cit.

Scales J. (1999) in Future Work and Lifestyles, Debate of the Age, published by Age Concern. Pahl R. (1999), 'Work and lifestyles: dilemmas of the age' in Future Work and Lifestyles, Debate of the Age, published by Age Concern

Walker A. and Maltby T. (1997), Ageing in Europe, Oxford University Press

Department for Education and Employment (1999), Age Diversity in Employment, London, HMSO

Cabinet Office (2000), Winning the Generation Game, A Performance and Innovation Unit Report, April, 2000

European Commission (1999a) Official Journal of European Communities, 21:12:99 (1999/C 369/03, Annex V). European Commission (1999d), Proposal for a Council Directive, Establishing a general framework for equal treatment in employment and occupation, (COM [1999] 565 final)

European Commission (1999b), Towards a Europe for All Ages - Promoting prosperity and intergenerational solidarity, Commission communication, 21 May, 1999 (COM [99] 221)

Midwinter E. (1992), Citizenship: from ageism to participation, Carnegie United Kingdom / Centre for Policy on Ageing, Dunfermline/London. Walker A. and Maltby T. (1997) op cit

Taylor and Walker (1992), quoted in Walker and Maltby, Ageing in Europe, Oxford University Press, 1997, p.80.

Glennerster H, (2000) 'Working Lives: delayed sunset', Guardian 17th May 2000. Cabinet Office, Winning the Generation Game, a PIU Report, April, 2000
The Human Rights Act 1998 came into full force 2nd October 2000

Debate of the Age (1999a), Values and Attitudes in an Ageing Society. The Millenium papers. Age Concern England

Scales J. (1999) op cit. Pahl R. (1999) op cit.

Prepared for LEAD by:
Lesley Cullen
Research Fellow
International Institute on Health and Ageing
University of Bristol
November 2000

INTERNATIONAL INSTITUTE
ON HEALTH AND AGEING LOBBY TO END AGE DISCRIMINATION