INTRODUCTION
In 1982 a group of Australian experts indicated that, for the elderly, Australia should articulate a clear national policy, develop a method for meeting needs and provide national and community programs to meet these needs. (Ageing 2000 - A challenge for Society, p.173).
Since that assessment was made much positive work has been carried out by the Federal Government to meet the weaknesses so identified. The general purpose of that work has been the provision of an integrated approach to services and income support. While the response has not been perfect it reflects a genuine attempt to match a concern for "quality" of life issues with the increases in life expectancy and the anticipated increase in the pool of our very old population.
Although this paper does not detail the programs currently available to support the elderly population it is important to acknowledge the range of services now provided through various Community Services, Health Care and Social Security programs, at little or no cost to the client, which seek to integrate pension and service cost provisions. This paper will discuss some of the major issues which still require resolution as well as providing a commentary on the current situation of the elderly in Australia. If such discussion is to be meaningful it is important that some working appreciation of the Australian context should be established. Accordingly, following sections will explore some of the history and geography of Australia; will establish the paper's conceptual approach and some of its assumptions; and, will provide some profile facts on the elderly prior to examining the present and exploring the future.

1. THE AUSTRALIAN CONTEXT
My intention is not to present a social-political history of Australia. My purpose is to provide brief comment on some important issues which may assist in explaining Australia's past and present attitudes to that section of our population called, the elderly.
The European occupancy of the Australian continent dates from only 1788 while that of its original people dates from the early centuries of recorded human existence. My comments focus on the post-1788 development of Australia and particularly on our post-colonial era, the twentieth century.
Australia has a land mass approximately equivalent to that of the Peoples Republic of China or the United States of America. It has a population of 17 million largely concentrated in large metropolitan cities situated along the coastal areas. We have a "developed" history of only 200 years which has witnessed the transition from a convict-colonial settlement to that of a democratic country. Geographically we are located in the Asia-Pacific region yet our culture is still largely Western-European influenced. Economically and politically our future is linked to that of the Asian region.
Australia's human resources are relatively small and scattered. We have a reasonably high standard of living but still retain inequalities amongst our people based upon class, gender and ethnicity. Co-operation between the Federal Government and the various State Governments has been largely determined by political allegiance and personalities rather than by common purpose and national priorities. However, a submerging of parochial political issues in the interest of the national "good" is becoming more attainable.
Our early history reflects the hardships and problems of a colony and convict settlement seeking to attain its political independence. The experiences of our forebears in those turbulent times "imprinted" particular attitudes on Australians relative to authority, independence, nationalism and egalitarianism. These, in turn, have been modified and re-defined by the impact of a massive post-World War II migration process. The resulting exposure to different cultural and social values has been a positive and en-during feature of the phenomenon. It has enriched the Australian character and has contributed to its resilience. Some 4 million of our population record their country of birth as outside of Australia.
During our transition from colony to nation the impact of our relatively harsh environment and the reality of our isolation from our European roots, encouraged within the people an inward-looking perspective and a fierce independence. Australians came to consider themselves as people with open-minds and open-hearts who would willingly protect the under-privileged. Thus the theme of "mateship" grew. (However, in the present age it is frequently difficult to observe this early and worthy characteristic in action.)
The nature of our early industrial history, our isolation and our social attitudes, have cultivated in Australians an attitude of social-welfare orientation. There is a prevailing view that "the system" or "the government" has the prime responsibility to make things better, or work, not the individual Australian. The force of this social-welfare mentality is reflected in the cur-rent policy and program provision for elderly people. It remains a powerful force but is changing, slowly.
The message of this introductory section has been that powerful attitudinal forces derive from our early history, our geographic isolation and our social experiences. These forces still influence the nature and direction of our present policy and program provision for elderly people. The powerful attitudinal influence of these factors must always be considered when we explore the future perspective of elderly care in Australia.

2. SOME ASSUMPTIONS AND PROPOSITIONS
Within the historical and attitudinal context outlined, the paper's conceptual approach and some key assumptions and propositions can be detailed.
The conceptual approach of the paper can be explored by reference to a basic social dilemma posed by C. W. Mills, in the 1970's.
Mills used the concept of personal troubles and public issues to highlight aspects of social change. As all issues related to the elderly in Australia involve some form of social change, Mills' idea is worthy of consideration.
Personal troubles are considered to be those events which occur within the range of one's immediate relations with others. They are person oriented and are limited to those areas of social life of which one is directly and personally aware. A trouble is a private matter where values cherished by an individual are felt to be threatened. (The range of "troubles" perceived by the elderly include at least those of income, health, employment, personal worth, pride and independence.)
Whereas a trouble has a personal orientation an issue is a public matter which by its nature transcends the local environment of the inner life. The private problem becomes an issue only when it cuts across many social groups and organizations. When it does become a public issue it is certainly likely to attract the attention of any government which depends upon consumer support and approval to survive.
The use of a concept, such as that developed by Mills, provides an underlying unifying theme. It seems to me that the difficulty for the elderly, both on an individual basis or as a group of persons, resides in the control and resolution of their inner-troubles, their self-doubts, their feelings of inadequacy and their removal from the mainstream of normal life, through the precarious criterion of chronological age.
The more "common" troubles become among the elderly the more manifest the opportunity to make these troubles public issues or matters. The art of the matter will be for the elderly to translate their key personal troubles into a cogent public policy (issue) form. The challenge for the elderly (both individually or as organized groups) will be to sensitize the public as well as the government to their "troubles", using an "issue" approach.
Unfortunately. I believe that there does exist an incapacity for many Australians to sympathetically respond to the "troubles" of the elderly in a constructive and altruistic mode. A failure to understand the time-perspective of biological growth appears fundamental to this incapacity. To compound this cognitive lapse is the absence of any "affective" compensatory reaction. My rather pessimistic view is that most Australians are too busy coping with the present (surviving and enjoying) to invest too much thought in the troubles of an elderly group who are (in theory) looked after by the social welfare system and medical technology. There appears to be some difficulty for most Australians to realize that "one day" they too will require the love, care, affection and respect of another generation.
I would now turn to four key assumptions. These assumptions, in turn, assist in defining four propositions which focus on key future issues. Hopefully the conceptual approach adopted, together with the assumptions and propositions made, will provide a coherent base to more closely examine the future for the elderly in Australia.

My four key assumptions are:
1) Old age, or to be elderly, is socially determined and defined.
2) Chronological age does not adequately reflect physiological age or functional capacity.
3) Age of retirement from work is more related to economic pressures and circumstances than to a loss of function.
4) The likelihood of becoming dependent on others is closely related to gender, race, class and ethnicity.
From these assumptions some key focus areas or propositions as to the future, can be derived.
(a) The balance between retirement, work and remuneration in retirement will become key policy and financial issues (financial).
(b) The increasing pool of healthy-active elderly will exert a major impact on the recreation and retail industries as well as the political process (political-commercial).
(c) The impact of political legislation designed to reduce gender and social discrimination will influence traditional caring patterns (social-political).
(d) The expansion of retirement villages, nursing homes and hostels will impact, negatively, on quality of life issues and the existing informal caring networks which are of minimal cost to government (social-financial).
Just how these propositions will be "balanced" by the social and political process is not clear. Likewise the nature of their resolution will be influenced, at any one point in time, by the world economic situation, the national political agenda, and the interest of the non-elderly Australian. They do, however, remain key focus areas for the future and are further developed in following sections of this paper.

3. SOME PROFILE FACTS: THE ELDERLY
Australia's population is growing older. While little change in the actual life-span has occurred more people are likely to reach the upper-brackets of life expectancy.
The present situation can be detailed by the following statistical information (Table l).

Table 1 The current spread of male and female age groups (elderly) throughout Australia (March quarter, 1990)

The current Australian population is just over 17 million and of these some 2,588,000 can be classified, by legislative definition, as elderly or aged.
Australian females have a greater life expectancy than for males: 10% greater at birth and 30% greater at age 65. At birth males have a life expectancy of 71.2 years and females 78.2 years. At age 65 the expectancy is 78.7 years and 82.9 years, respectively (Nursing Homes & Hostels Review, p.18).
Australia's elderly population, defined as age 60 for females and 65 for males, is not homogeneous. There are wide and diverse ranges of life-styles, attitudes to work and leisure and to the various welfare service provisions available. Our elderly are an active, mobile and informed section of society. While the majority receive federal age pensions and health support some twenty-two percent remain independent from the welfare-benefits given to their elderly peers.
As at August, 1990 there were 1,344,430 people in receipt of either the full-age pension or part-pension. The full-pension entitlement is $141.20 per week for a single person and $235.40 for a married couple.
The age pension is a federally funded and managed financial system which provides essential support for many retired Australians. It should not be considered as the sole income source although for many Australians it does become their major and only source of income.
To be eligible to apply for an age pension males need to be 65 or over and females at least 60 years of age; you must be an Australian resident; you must be living in Australia when the application for a pension is made; and, you should have lived in Australia 10 years continuously at any time.
Those receiving the full-age pension are permitted to earn $40 (single person) or $70 (married couple) before any reduction is made in the age pension received. For every $1 above this threshold the pension is reduced 50 cents.
As to the "growing older" or demographic aging of Australians, a simple way of portraying this situation in Australia is that many more people stay on the train of life till the journey ends rather than alighting at intermediate stations along the way. The net result is that the "seating" occupancy rate has increased for a longer journey than in the past. Because of the longer journey now enjoyed by more people the services required to provide the "best" trip possible are now under strain. The extent to which the Australian population has "aged" during the last 105 years can be illustrated by reference to the A.B.S. "Population Age Pyramids" of 1881, 1933 and 1986.
It is stated by the A.B.S. that the proportion of the population aged 65 years and over has increased from 2.2 percent in 1881 to l0.5 percent in 1986 and to l0.7 percent in 1987 (p.123) (Figs. l, 2). In examining statistics on the age structure the important impact of migration flows should be noted. It is claimed that "rapid declines in fertility, and to a lesser extent, mortality, have contributed significantly to the ageing of the population in the 1970's and 1980's. However, the increase in migration flows as well as emphasis on family migration, have tended to delay this process" (p.125).

Fig.1 Population age pyramids, Australia (1881 Census)

Fig. 2 Population age pyramids, Australia (1986 Census)

The demographic picture presented indicates that two key propositions will impact on future policy and program provision:
1) An increase in the number of the aged, relative to the young, and
2) Economic conditions and technological development will lead to changes in the work and social environments.
The issue of changes in work environments, from a gender perspective, is particularly important for elderly care.
The working out of the multitude of social and industrial issues stemming from the "gender" issue will be further complicated by Australia's dependence on the stability of the world economy and the very strong support now accorded to the rights of women in employment by both union groups and governments, alike. The recognition that gender has been a major factor which has prevented women from "progressing" in the work-place is likely to erode the supply of "daughters" who provided care and support, in the home, for parents, usually on an unpaid basis. This Australian phenomenon of reduced inter-generational support, assisted by industrial agreements (equal employment opportunity and affirmative action policy), has not been fully appreciated. Its net result will be that of a further demand on the "government" to provide welfare services to assist women enter the work-place and to progress according to ability, not by gender. It will likewise have major funding implications for the welfare of older persons because of the "withdrawal" of family services and support. Perhaps it is the grand-children, not the son or daughter, who will be "socialized" to fill the likely gap in existing inter-generational linkages? It is a fertile research field and has been identified in the introductory section of this paper as a key focus-area for the future. With some major profile facts established an examination of the present and past condition of the elderly in Australia can be undertaken.

4. THE CONDITION OF THE ELDERLY
Russell & Schofield have examined the situation of the elderly in the context of the health service network. They contend that many of the health problems of elderly people are not caused by the ageing process per se, but by the same diseases and environmental stresses that produce illness in all age groups (p.126). They further argue that it is not longevity per se that creates problems, but the social condition in which it is experienced (p.128). Clearly these two researchers seek to establish that an analysis of policy and program will lead to the conclusion that race, gender, class and ethnicity are powerful forces which impact negatively upon the conditions which an elderly person is likely to experience and contend with. Ultimately these forces will determine the nature of the health care provision received.
Kendig, writing in 1986, claimed that relatively few older people were lonely or had unmet instrumental needs. However, he also remarked that "satisfaction" can reflect low expectations rather than a high quality of life (p.57).
Perhaps it is unfair to suggest that the political response to policy and program provision for the elderly ebbs and flows according to the lobby pressures and the time of the next elections. However, it is fair to claim that a more equitable policy towards the provision of services for elderly people has been achieved, irrespective of the political or economic reasons for such policy and programs. The present Federal Government has mad positive and constructive steps in this matter.
The peculiarities of the Australian system of government allocates to the Federal Government particular responsibilities for health and social welfare but reserves some policy and service areas for each State Government.
To the credit of the present Federal Government a deliberate policy of service provision based more on hostel settings and community services than on the previous institutionalized nursing home approach has been pursued. By budget decision a redistribution of resources has been achieved in line with the above policy. However it is always appropriate to ask the question is this a successful policy and does it provide the economic and social advantages it purports to attain? Another section addresses this matter.
The planning framework for aged care policies (national) and the redistribution of Federal Government resources for the care of the aged, has been based on the following general principles:
･ Aged people should, as far as possible, be supported in their own homes.
･ Aged people should be supported by residential services only where other support systems are not appropriate to meet their needs.
･ Services should be provided in an atmosphere and using processes which promote, as far as possible, rehabilitation and restoration of function.
･ Services should be based on a recognition that for many people discharge to a less supported residential service or to a community based service, will be a possible and desirable outcome.
Present Government policy encourages the elderly to retain their own residences and to utilize a wide range of domiciliary services to provide for their health-needs and home-needs. It does however, by sing age-related milestones, prescribe when "old-age" has been attained, when employment may voluntarily cease, when and how pensions commence and what health-related benefits can be secured.
The rules which determine age pension eligibility are strict and complex. Currently, for lNCOME a single person's pension is reduced by 50 cents for every dollar of non-pension income in excess of $40 per week.
For couples the figure is $70 per week. For ASSETS, which include practically all possessions as well as any investments, the pension is reduced by $2 a week for every $1,000 of assets held in excess of the specified thresholds. For signal homeowners who wish to receive the full pension the figure is up to $103,500 and for a married couple is up to $147,500. For non-homeowners it is up to $177,500 and $221,500, respectively.
The income and assets tests operate side by side, but only the test which results in the lower rate of pension applies. The family home is not included in the asset calculation.
In addition to the aged pension the most important benefit operating for most (not all) pensioners is the health benefit card. This card entitles the pensioner to reduced cost pharmaceuticals, free dental care, free ambulance service, free supply and maintenance of hearing aids. The health card also establishes the eligibility to receive discounts on telephone rental, electricity, gas, water rates, driver's license and car registration. Many Local Government authorities also give cardholders substantial reductions in municipal rates. Those pensioners who are eligible for the health card also enjoy substantial concessions on public transport.
To be eligible for the health and transport concessions card a single pensioner can earn no more than $95 per week and a married couple cannot earn more than $164 per week. Eligibility also depends on a limit to the assets owned by the pensioner. For a single person homeowner $118,000 is the limit and for a non-homeowner $192,000 is the limit. For couples the limit is $169,000 and $243,000, respectively. These are 1990 levels.
It should be carefully noted that of the total number of elderly people (using the age levels which determine eligibility for an age pension - 60 years female and 65 years male), the majority are age and service pensioners but some 22 percent receive no Government pension at all.
The facts on retirement income can be portrayed using the 1989 Federal Government's policy statement on the matter:
First of the 2.2 million people of age pension age some 1.7 million are aged and service pensioners.
Second, approximately $10 billion each year is spent on these pensions.
Third, this outlay comprises nearly 75 percent of all income received by age and service pensioners.
Fourth, 13 percent of age pensioners have no other income and a further 33 percent of age pensioners have other income of $1O a week or less.
Fifth, 31 percent of age pensioners do not own their own home.
Sixth, by the year 2021 there could be 3.9 million people aged 65 and over representing 18 percent of the population compared with 1.9 million or 11 percent in 1989 (p.3, Better Incomes).
The Government has no doubt that our future elderly will be "helped", and enriched, if they are encouraged to save for their future, rather than spend for the present. The preferred form of such saving is the superannuation mode. This, combined with the age pension, will provide an effective national retirement income policy. Basically, the proposition is sound. It will reduce the pressure on public sector services (government funding) and shift the cost to the person seeking the service, which will normally be offered at commercial rates by private contractors.
The present Federal Government view is well recorded by the following statement of the former Minister for Social Security (1989) :
"... meeting the expectations of higher living standards for the retired in the future will be possible but only if we can provide better employment opportunities for older workers and for women" (p.21, Better Incomes: Retirement Income Policy).

5. SOME FUTURE ISSUES
The issues which are likely to occupy much of the consumer, researcher and politician's time include the following:
The Economics of Elderly Care, Work & Retirement, The Role of the Young, Research, Recreation - Leisure, Euthenasia.

(1) The Economics of Elderly Care
Not surprisingly in a relatively high-tax level country such as Australia, the most obvious recipients of the welfare dollar - the unemployed and the elderly - become targets for expenditure cuts when any form of economic stagnation become palpable.
lrrespective of the accuracy of the perception that the elderly eat up the health care bill, there is a continuing interest by government in Australia to shift the cost to the consumer by what are called privatisation measures. The attraction of off-loading those large budgetary concerns (institutions) to private industry which will run services for profit, is attractive to both conservative and reform governments, alike. Additionally there is continuing concern that the current pension system requires review.
Given the prospect of profit I have little doubt that many commercial groups will provide services. However we should be reminded of the advice of Graycar on this matter. He argued that health and welfare services are not consumer commodities that can be bought and sold in market situations like used cars or soap powders. Further he argued that the situation which necessitates their usage is usually produced by stress or anguish rather than by free choice. (i.e. market place conditions) (p.71).
There appears to be good reason to promote an economic formula based upon the three principles of using the family as a unit for care, utilizing the community rather than institution and developing appropriate services which are not necessarily of high cost.
Each of the above merits examination and critical analysis.
An emphasis now is placed not on input-specification but on setting broad outcome goals, particularly in relation to the quantitative outcomes of the services provided.
It would be fair comment to propose that the Federal Government is seeking to encourage nursing homes to consider the following aspects which collectively focus on the quality of care issue:
Health Care, Independence, Rights of Residents, Homelike Environment, Privacy, Participation in Activities, Comfort and Safety.
While standards can be specified their achievement, and the evaluation of their achievement, is more complex.
Within Australia there is general agreement that evaluation of structure, process and outcome provides a useful model under which evaluation can be undertaken.
According to Russell & Schofield the nursing home industry provides a very clear argument to caution against such privatisation, if access and equity are to be retained as key principles determining need and access. These researchers point out that the development from the 1960's of nursing homes as the main publicly supported means of care for the chronically ill, particularly the aged, was an "official" answer to problems in the health insurance system. The creation of the private nursing home industry and the introduction of community services was designed to assist government curb of institutional care (i.e. government) (pp. 186-187). The result has been a highly subsidized nursing home industry and the development of a highly motivated and effective lobby group.
In a June, 1988 study of Nursing Homes for the Aged it was stated that the average nursing home resident could be characterized as an 82 year old woman, born in Australia, widowed, in receipt of an aged pension, who lived alone in a house or flat prior to her admission to a private nursing home from a hospital (Nursing Homes for the Aged - A Statistical Review June, p.12).
The same study revealed that in 1988 there were 1,417 nursing homes for the aged, providing 72,ll6 beds for frail aged persons who required ongoing nursing care. These beds were complemented by 43,000 subsidized places in 987 hostels which provided "base level" hostel care or more intensive personal care services (p.1.).
The level of bed provision provides approximately 100 nursing home and hostel places for each 1,000 persons aged 70 years and over, in Australia.
In 1988 the hostel places were provided by non-profit organizations but 48.4 percent of the nursing home places were provided by the private sector.
It is of interest to note that in a 1986 research review of residential care it was proposed that "there is considerable misuse of nursing home care by elderly people who do not require that level of care" (p.125). The cautious conclusion suggested that in Australia a conversion of 20-30 percent of nursing home beds to hostel beds providing personal care was appropriate (Nursing Homes & Hostels Review, p.126).
The field of the economics of elderly care is one research area of need and interest.
The community-care concept is highly commendable as it purports to provide services for the handicapped elderly in the "home" situation. Again Russell & Schofied are quite sceptical of the claims of cost-effectiveness and quality of life which support the home-care movement. They identify factors such as relatives being the major provider source; the absence of full-costing research; the assumption that home-care enhances quality care; medical control of social problems; the frail elderly are particularly isolated (pp.189-191). It is obvious that careful research on the extent and cost-effectiveness of the home-care service is required. An undcniably good idea requires research evidence to support, modify or revise its policy and program parameters.

(2) Works and Retirement
Human development is typified by individual differences and rates of growth within a continuum of commonly shared experiences. Chronological age is not a good measure of physiological capacity or functional intelligence. Adolescence provided a clear example of the great diversity in the timing of the physiological and anatomical growth milestones for similar aged children. The same applies to the elderly: people "age" at different rates. Hence, flexible retirement age options should be provided together with opportunities to utilize the experience and skill of these young-old people. Fractional, part-time and periodic employment contracts should become more available to utilize their skill, wisdom and experience.
It is inevitable that such a move to provide an extended working career will raise issues of pension eligibility, health benefit, taxation levels, retirement and superannuation policy. Nevertheless, if we in Australia are to seek answers rather than postpose decision, these financial issues must be addressed without the philosophical-political ideology arguments which seem to still dominate our political-social decisions.
For many Australians the opportunity to be classified as "old", in age-determined welfare terms, is seized with some delight. On the other hand for many it is an unwelcome and forced withdrawal from the work-force, dictated by legislation and superannuation (pension) requirements.
Time has moved the concept of a universal protection of the elderly from that of a blessing to one of a mixed-blessing. Time has also moved the older quantitative model of retirement (age-determined benefits) to one which addresses more qualitative aspects, with greater opportunities to "enjoy" life in retirement. The future literature on the elderly and ageing will more and more explore, and reflect, concepts of the quality of life, self-perceptions, a continuum of elderly function, personal responsibility, healthy activity.

(3) The Role of the Young
If we consider the amplifications of the inter-generational gap and its manifestations it may appear somewhat trivial to point to the experience of many Australians which testify to the empathy and strong bonds which form between many grandparents and grandchildren. This bond is of a reciprocal nature.
The utilization of our often maligned "youth-population" to provide care, affection and loving attention to our elderly population is a proposition which merits close examination and trial. The utilization of the services of these young people to act, in a remunerated capacity, as care-givers, companions or attendants would make both economic and social sense. It would be relatively simple to research the feasibility of such a program utilizing school groups, clubs or voluntary organizations. Its focus would be on qualitative outcomes rather than those of a more quantitative nature. The utilization of other population groups is not excluded by the above proposal.
The premise upon which this idea is based is simply that man is equipped to provide human contact in a friendly and co-operative manner. Why not exploit this quality and test its application in the social settings of the elderly?

(4) Research and Education
This paper has identified a number of areas in which research effort would be valuable. To date much research has tended to concentrate on conditions or human circumstance, whereas the actual field of the elderly is replete with problems - i.e. situations requiring resolution.
In the future our research should revolve around the central issues which are derived from the responses received to the simple questions: What are the elderly's problems? How can they be approached and researched? How can an action program be initiated which utilizes the results of such research? The need remains for action plans to be proposed and argued, based upon the researcher's analysis: The time has passed when society can simply receive research advice couched in scientific language to protect the researcher rather than to arouse, inspire and provoke society and the decision makers, namely the politicians.
Discussion of research automatically leads to the question of education for the service providers and the public at large, relative to thc problems and pressures experienced by the elderly.
Australian educational institutions providing tertiary level study have not been quick to alter or modify existing programs to better "prepare" their raduates for the emerging future of elderly care. The same observation can be made relative to disabled people and their special support requirements.
Both at under-graduate and post-graduate levels there should be an emerging emphasis on treatment skills and on the behavioral dynamics of ageing and its social context. Skill in treatment modalities will not be sufficient if isolated from the broadening understanding of the physiological and behavioral process of ageing.
A further challenge for the educator is the assimilation of non-Western approaches to our treatment. The use of non-invasive techniques, such a Shiatsu, is becoming more widespread and the considerable interest in its application to the elderly has prompted the Cumberland College Foundation to sponsor a tour of a leading Japanese Shiatsu educator and clinician, next year.
While I remain generally critical of the response of our tertiary institutions in preparing professionals to work with and support our elderly, there are examples deserving of recognition. Without appearing too parochial I would refer to the recent establishment of a School of Community Health at the Cumberland College of Health Sciences, an academic college of the University of Sydney. Programs offered by the faculty of this School attract medical practitioners, therapists, nurses and professionals working in the social and behavioral fields. A companion Research Centre for Women's Health, assists the interaction of the learning experience and the research field, in a multidisciplinary mode.
On the broader front of community "education" as to the troubles and problems of the elderly, much has to be done. I have suggested that the Australian public is generally well-meaning but quite passive in their interface with our elderly population. Unless personal circumstances dictate most Australians would prefer to ignore or by-pass the situation of our elderly people. Such a reaction is understandable and reflects an attitude that says the "system", which uses our taxation money, should provide for the elderly, not me, the individual. Again I would suggest that our geography, social and political history are strong factors in sustaining such attitudes. However, that fact does not excuse such attitudes based upon ignorance, apathy and, at times, prejudice. More must be done, in a public sense, to argue the case that all of us will be elderly, one day, and that self-interest alone should prompt public support of programs which will enhance the quality of human experience, particularly that of the elderly.
Hopefully, the motivation will be richer than that of self-interest.

(5) Recreation - Leisure
A change from "passive" to an "active" philosophy of patient care is long overdue. The use of regular programs of outside sport, excursions, plays, singing, and games is well known, and applied (Fig. 3). The active involvement of elderly people in such activity should be extended and not reduced. A further dimension of the active philosophy is that of physical exercise or training. Generally, such a positive approach, scaled to the needs and capacity of its participants, has not been widely applied in Australia. The use of any easily managed and delivered system which can facilitate the mobility and physical capacity of the human system must become a regular aspect of the leisure continuum.

Fig.3

The development of simple programs which utilize physical activity and mobility is encouraged not purely from the recreation/leisure perspective but also from that of positive physiological benefit to the person.
The general argument of this paper is simple: all human systems benefit from activity and use. Age, per se, is not a sufficient reason to ignore or preclude elderly people from activities of a physical nature. The longer mobility and physical movement can be sustained and enhanced the more likely a "quality' of life will be retained.
When the benefits of "exercise" are being promoted it is first of all "compulsory" to acknowledge that the evidence presented is frequently contradictory, is beset by sampling and methodological problems and does not produce evidence which permits isolation of the effects of ageing, per se. For those of academic persuasion the recent summary provided by Stamford (Exercise and Sport Sciences Reviews Vol. 16, 1988. pp.341-366) merits close examination. For purposes of this paper it is suitable to extract from Stamford's summary of the review of research on "Exercise and the Elderly". He makes the following cautious comments:
1) Elderly males and females are capable of demonstrating a training effect in response to endurance training regardless of physical activity patterns and current training status (p.365).
2) Strength can be increased in the elderly through training but the adaptation made may differ from that observed in younger subjects (P･365).
3) There is a substantial loss of muscle mass and an accumulation of body fat (p.366).
4) Exercise training appears to prevent bone loss and may even increase bone mineral content in the elderly (p.366).
5) Exercise may also improve joint function, which has a tendency to dissipate with advanced age (p.366).
In addition to the above there is great current interest in the development of a "growth" hormone which can reverse some of the above physiological conditions. However, much more work is required before this approach can have universal cost-effective application.
What is the impact of such research and its value?
If an approach conducive to "quality" of life is to become predominant in the future services provided for the elderly, full utilization of Australia's environment must be taken. Outdoor excursion opportunities, combined with indoor activities which actively promote the physical participation of the elderly person, must replace those passive activities such as TV-watching or the "passive" securing of the person to chair or bed. There is little excuse, other than manpower, to ignore the benefits of a carefully prepared program of physical activity. Whether the professional advice is readily available (both existing or attracted by level of remuneration) is a doubtful issue. However, mechanisms based upon regional networks and utilization of the skills of health professionals (e.g. physiotherapists, occupational therapists) can be effective and can deliver a focus which is active, constructive and relevant. There is little reason to argue the case that nursing homes or retirement villages should be shrouded by passive pursuits.
While the above arguments focus on the physiological aspects o excercise there is no reason to doubt that a companion "psychological" enrichment could be associated with any increases in physical mobility or function. The biological-psychological manifestations of exercise certainly merit research attention.

(6) Euthenasia
In the next decade the frank discussion of the social, moral, religious, medical and ethical issues surrounding the euthenasia issue will become a pressing imperative. It will certainly bring forth the religious and medical arguments and the ethical issues will be based upon particular philosophical views. It would be my expectation that the political issue for a democratic society such as Australia will be the translation of the principle of freedom-to-choose by the individual into suitable legislative provision. Personally I have little argument with the notion of a voluntary decision on the matter. However, its complexities are acknowledged and the heart-felt convictions of many sincere groups will make the political process a very sensitive exercise.
While my anticipation of the range of arguments may be less than complete I feel certain that the following issues will be raised: withdrawal of life- saving support by modical practitioners (based upon voluntary euthenasia) as distinct from switching off life-support from a brain-dead patient (medically defined); the difficulty of formulating effective legislation allowing voluntary euthcnasia because the number of checks and balances inserted (by lobby groups) would makc the legislation unworkable; the last minute change of mind from voluntary request to "keep hoping" attitude; increase doctors responsibility from withhold or withdraw life-saving procedures to active assistance in terminating life.
In Australia each State has the responsibility for legislation on this matter. At the moment in Victoria and South Australia individuals have the right to refuse life-saving treatment. In Victoria a patient on life-support can appoint an agent to carry their "proxy" if the patient becomes incompetent. In New South Wales active euthenasia is forbidden and the same applies to all other States.
It seems inevitable that the issue will become one of highly emotional nature, with proponents arguing the case on both sides. In the end I believe it will become one of the right of a person to control his or her circumstances, not only politically, economically and socially, but also in determining when a life-span has been fulfilled. Personal choice will always be paramount in Australia and will be valued above that of the politician and the self-appointed guardians of "health", the medical profession.
If I can conjure up in my mind the thoughts of dignified, loving and sensible people who choose euthenasia as a method of ceasing their life on earth then it would have to be in terms of "self-hood". This concept is richly developed in the author's Preface to that classic - "A Man For All Seasons". Bolt ascribed to Thomas More an adamantine sense of his own self. More had attained that most interesting of situations, according to Bolt, of knowing where he had finally located himself, his beliefs and his principles. As Bolt said: "He knew where he began and left off, what area of himself he could yield to the encroachments of his enemies, and what to the encroachment of those he loved ."
I would like to believe that such a process typified the thinking of those who profess and choose euthenasia. I would also trust that my particular view is not offensive to others with different cultural, racial or religious backgrounds.

7. CONCLUSION
The theme of this paper has been that the "elderly" of Australia should recognize their own skills, ability and potential to contribute to Australia's future. Likewise it has been argued that this potential will only be achieved if "friendly" and constructive policy decisions are made by government within the dynamics of the political arena. The elderly are becoming a significant political force, reinforced by early retirements and the demographic trends outlined in this paper.
Their electoral impact is real and their consumer purchasing power is of considerable proportions. These factors combined with media attention exert a potent influence on all political parties. The political influence of the elderly person (whether independent or receiving a government pension) will increase, in the future.
The views of the elderly are expressed, collectively, through a variety of associations and groups. There are State and Federal bodies which all claim to "represent" the views of the elderly. Not all the "elderly" are members of these groups or are active in their discussions or activity. Irrespective of how we rationalize the concerns of the elderly population for social support and health care it appears that the following matters reflect their hopes and aspirations for the future:
1) A system of care which permits a person to remain in their own home, or their family's home, for as long as possible (independence).
2) a system which permits a person to move to an appropriate level of residential care when, and if, such a move becomes necessary (physical security).
3) A system which provides an age pension which itself serves as an adequate base income to meet the normal needs of daily living (economic security).
4) A system which does not penalize the person who wishes to carryon with some part-time work by canceling their pension eligibility or reducing it significantly (incentive to remain active).
5) A system which will provide health care services which are easy to access and utilize but still within their capacity to pay (economic cost of health care).
6) A system which provides a legal framework in which informed decisions can be made and respected concerning euthenasia (control of life-span).
7) A system which recognizes the dignity of the human spirit and which provides an environment in which it can prosper (self-esteem and dignity).
Hopefully, the initiatives of government, combined with an attitudinal change in society, will enable such programs to become accessible to all elderly Australians who require such support.

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