Will you still need me, will you still feed me when I'm sixty-four?
According to the results of a national census carried out in 2001, the population of the Czech Republic is ageing. People live longer and fewer babies are born. Improved healthcare and a healthier lifestyle are thought to be behind a rise in the mean life expectancy of Czech population. But the fact that there will be more people relying on pensions who will also live longer, and that, on the other hand, there will be fewer people working to provide for them, worries the government and all those who are affected by the ageing trend, such as doctors and social workers.
Dr Iva Holmerova is the head of the Centre for Gerontology in Prague.
"I think that our country is very well compared to other countries of the developed world. Our population is getting older and older and the most rapidly increasing figure is the number of the so-called "old-old". The total number of the population over 65, that means senior citizens, is about 1,400,000, which means it is more than 13.8 percent of the whole population. The population of the capital of the Czech Republic, Prague, is much older still and it means that health and social policy should adapt to this demographic trend."
However, Dr Holmerova says that services for the elderly and old are still inadequate in this country. She also says that geriatricians encounter many obstacles in their work - for instance they are not allowed to prescribe drugs for treating Alzheimer's disease or mobility aids for the disabled elderly. Dr Holmerova points out that caring families should be given more support from the state and their assistance should be preferred over institutionalisation of the elderly, which is ultimately more expensive for the state.
"I would say that care in this country is a bit over-institutionalised and over-medicinalised. The need for subsidiarity is not respected, which means the development beginning with the care of a caring family and supporting the support of the caring family, then supporting the independent living of older persons in their families and in their villages, towns, communities. And then it is necessary to create a network of services for those people staying at home, and only after that do those people need hospitals and institutions. That means that the development of those services must be subsidiary."
Old age usually brings along health problems, both physical and psychological. Dr Vladimir Pidrman from the Psychiatric Department of the teaching hospital in Olomouc says that the prevalence of psychological disorders in the elderly population in the Czech Republic is comparable to other developed countries.
"As for the number of people, I think it's the same as in Europe and the United States. It's true that there are differences between the Czech Republic and Europe on the one side, and Africa, for example, on the other. But our prevalence is the same as in the industrialised countries."
Dr Pidrman says that while Czech senior psychiatric patients now have access to up-to-date medication, the situation concerning care for the elderly is far from ideal.
"I think we, psychiatrists, are happy because our possibility to treat dementia, Alzheimer's disease and so on is the same as in other countries in Europe and in the United States. We have all the necessary drugs and we have all other possibilities, for example some training programmes for patients and also their families. Maybe one problem is institutions, homes for old people and so on. I think there is a difference between us and Western Europe because progress in our country is a question of the last ten-twelve years, while in Western Europe it has been developing ever since after the Second World. So the problem is in the social background, I think."
Psychiatrist Vladimir Pidrman sees a problem in the attitude of a post-communist society towards its senior citizens who have every right to lead a life of dignity, preferably in their home environment, and enjoy the respect of the community which should have more understanding for their particular problems.
"I think that on our part - the psychiatrist and gerontologists, this attitude is fine. But on the part of society there are a lot of problems because I think the general opinion is that the society has other "more serious" problems. But I think a great step must be made in the topic of care for older people because in this field, I'm afraid, we are still in the 1980s, maybe."
To catch up with the rest of the developed world, steps need to be taken primarily on the part of the government. That's something geriatricians Vladimir Pidrman and Iva Holmerova agree on.
"I remember the situation since the early 1990s when I became active at the Centre of Gerontology in Prague. I think at least there are some proclamations. In the governmental policy there is a proclamation that care should be taken of older persons, that the policy should be adapted to the needs of older persons. At least that. But I think it's very necessary not only to declare but to act and to develop the necessary law for health and social care for older persons."
On Sunday representatives of the ruling coalition met to discuss a reform of the pension system which has also been criticised by the European Union. Odile Quentin is the Director General for Employment and Social Policy of the European Commisssion.
"It's very clear that the pension system is faced with the demographic ageing challenge. By the way it is a problem not only for the Czech Republic but it happens in all European countries. There is a need to reform the pension system with a view to have them financially sustainable so that they can continue to play their role of being socially adequate. In this context we would strongly support a reform of pensions in the Czech Republic, which would allow for stronger incentives for people to stay longer in the labour market to limit the possibility of prior retirement which hurts both the public finances and the workers themselves and to allow people in a flexible way to continue to work later if it is needed. So we strongly encourage this kind of reform, which is in conformity with the objective that the European Union adopted two years ago to combine this financial sustainability with social sustainability. We know it is a difficult discussion everywhere, it will be a difficult discussion in the Czech Republic as well, but it is necessary if we want to safeguard the pensions for the future."
On Sunday, the government ministers launched discussion on a reform of the pension system which proposes postponing the retirement age to 63 for both men and women after 2007. The reform, which will be debated more thoroughly in June, should also make prior retirement disadvantageous, encouraging people to stay longer in the labour market. The current state is no longer sustainable. Here are a few figures: in 2002, the Czech Social Security Authority received 77,000 new applications for old-age pensions. At the end of 2002 the state paid out 1.9 million pensions. About 2.5 million Czechs in the productive age are voluntarily saving money in various pension schemes. The volume of pensions the state pays out amounts to nine percent of GDP and the proportion is expected to rise further.
