The demographics make clear the need for these policies: a 50 per cent increase in the numbers of over 65s by 2030 and a 100 per cent increase in those over 80. Life expectancy at 65 is already nearly 20 years, and by 2030 it will be 23 for men and 26 for women. This represents a victory for wider public health and for modern medicine, with many older people reporting high levels of happiness, health and wellbeing. Older people continue to contribute to society as spenders, in paid work, as volunteers, carers or grandparents. It’s definitely time to shift from the tired, ageist narrative of 'burden', 'time bomb' and 'tsunami'.
But at the same time we have to be realistic about the implications of ageing on our health and care services. The biggest spend across primary, secondary, community and social care and prescribing is on older people. There are major variations in activity (eg, rates of hospital admission or care home placement) and inefficiencies in transferring older people between services. In this time of austerity, it is imperative for the whole system that we get care right for older people with complex needs.
Local service leaders are fully aware of this, and various plans, programmes and pathways for older frail people and those with complex co-morbidities are in development. But these plans are often focused on only one group of service users or one or two parts of the pathway. They have also been developed by serial 'pilotitis', fostered by short-term initiatives and leading to duplication.
So what is required to deliver the right kind of care for our growing older population? Our new report aims to equip leaders with evidence and practical guidance for whole systems, end-to-end redesign across all services and all stages of health for their local older population. The components of care can be seen in the following diagram: click to enlarge
We do, however, emphasise that these interventions shouldn't just be parachuted in without considering the local context and a range of related services being conducive to change. This won't work. On the other hand, the practical examples in the report illustrate that, even in the face of austerity and upheaval, improvements can be and have been made. We are currently just too slow to adopt proven service improvements or innovations.
For change to happen, we need to end the silos that place prevention and public health, long-term conditions, acute care, intermediate care, long-term care and end-of-life care in separate plans and pathways. We must realise the fundamental interdependency of each component of care. For instance, if we focus on healthy active ageing, we may reduce progression to dependency and high service use; if we can assess and treat older people properly when they present to acute hospitals, they are more likely to be alive and at home up to one year later.
It's also important to move away from a constant focus on organisations and who is providing care, and look instead at components of care – older, frail people or those with multiple complex co-morbidities, including dementia, will not have the same needs as younger or less medically complex patients. People should not be denied adequate investigation, assessment or support merely because of ageist assumptions. Often someone who is falling; becoming immobile, confused or incontinent; or is struggling to manage at home can have underlying medical causes that should be investigated and treated. At the very least, rehabilitation, equipment or support can help them to retain or regain their independence. We should never assume that 'it's just their age', or that the only thing that counts is compassionate care. Older people deserve access to the same range of services as younger people, and we should still be trying to help them to get better.
See more on this report
- Read the full report: Making our health and care systems work for an ageing population
- See and share our slideset on the practical lessons from this report
- Catch up with our related work on care for older people
- See our press release on the report