• Overview
• Definition
• Incidence, prevalence and trends
• Risk factors
• Health consequences
• Costs
• Contributors

Overview

We live in an ageing society. The older population is growing at twice the rate of the population as a whole. ¹ This is a worldwide phenomenon, and longer life expectancy and declining birth rates are the two contributing factors. In the UK a report by the Audit Commission said: "It becomes a question of whether we will manage change, or whether change will manage us." ²

In health and social care there is a pervasive tendency to regard all older people as infirm and frail and as having chronic health problems. Most, however, are healthy, active, socially engaged, and independent.

It is critical for older people to maintain their independence. One indicator of loss of independence is entry to long term care. About 96% of people aged 65 and older live in their own home. ³ Housing, social, and health care policies have helped to keep older people in their own homes and these policies will need to be further coordinated and extended to employment, transport, and pensions.

Postponing disease can reduce the number of late life years spent with disability. ⁴ This is called the compression of morbidity paradigm. ⁵ Quality of life, however, is compromised only when a longer term condition causes functional limitation. ⁶ Increasing the level of physical activity and exercise throughout life can contribute greatly to improving health, wellbeing and independent living in old age. There is substantial evidence that community based services including falls prevention, stroke rehabilitation, and general rehabilitation can make a real difference to the lives of older people. ⁷ We also need greater emphasis on care systems that are consistent with the needs of older people with complex requirements. A census study in one hospital identified 69% of patients as having complex needs and requiring multidisciplinary team care. ⁸ The current situation has been aptly summarised by Rockwood: "We have largely designed a system to care for people who have only one thing wrong at once, but which is chiefly subscribed by people who have many things wrong." ⁹ The challenge is to put in place a whole system approach for older people with complex needs – one that integrates social, voluntary, primary, community and secondary care sectors.