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Liberal ideas about personal autonomy, choice and independence emerged internationally in the 1960s. Changing agendas permitted younger people to make choices, even if risky, but older people were perceived as inevitably vulnerable, and despite their experience of life, their wishes were frequently ignored. For older people, clinically and scientifically, things edged on, albeit slowly. Promises of new services for an undervalued sector of the community were particularly vulnerable to political and economic fluctuations. The leadership had to advocate persistently for older people to receive appropriate levels and ranges of care equitable with those provided for younger adults. Ongoing and ageist themes over the fifty years have included prioritising services for younger patients; the double whammy of stigma of mental illness plus old age; and policy decisions based on short-term economic calculations rather than likely health and well-being outcomes.
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