Whether or not people are living longer and healthier lives, or whether they live longer lives in poor health, is of great significance. Not just for the individuals themselves, but also for the knock-on effects in terms of the need for health care and support.
The "compression of morbidity" is a term that demographers use to refer to the idea that people can live longer lives, with the period of ill- health or dependency compressed into a short period at the end of their lives. This can be contrasted with the current experience of many older people, who spend perhaps the last third or quarter of their lives in poor health and discomfort. Clearly, the big question must be: how can we ensure that the compression of morbidity becomes a reality?
Think about the images associated with old age - the characteristics of the "doddery old dear" that are currently in use in a commercial for gravy, or Shakespeare's vision of the Seven Ages of Man, which ends in the doom-laden "sans teeth, sans eyes, sans taste, sans everything".
Old age, according to these stereotypes, is characterised by poor mobility - joint problems, and a tendency to fall; by failing sight and hearing; by dementia, and by incontinence. Hardly an attractive picture, but none of these conditions is necessarily a feature of growing older.
Of course we all grow older, and there are certain features of this ageing process that appear to be unavoidable, although they are changing. These are things such as the loss of elasticity of skin, the slowdown in cell replacement, the thinning of bones. But these are not illnesses. There need to be clear strategies for preventing the development of many of the chronic conditions that are suffered, and for reducing ill-health and disability associated with the conditions that are often experienced in old age.
The postponement or avoidance of chronic illness is something in which we all have a vested interest. Reducing the need for medical intervention and for long-term care is better for all of us; it would promise a better quality of life, and offers the prospect of far less onerous demands on public expenditure.
Conditions such as strokes, osteoporosis, osteoarthritis, dementia, sensory impairment and incontinence are not the only ones in which there is scope for prevention and morbidity compression. However, they are probably the most important areas in which we should begin. It is likely that improvements in any of these areas would have wider, spin-off benefits elsewhere, such as in improved mental health and the reduction of depression in old age.
But these benefits will not happen just like that; we cannot leave them to chance and simply hope (with fingers crossed) that morbidity compression will develop naturally over time. There has to be an active investment in ageing research, and in prevention and rehabilitation, as well as in treatment and cure. In short, there has to be a commitment to a strategy for healthy ageing, not forgetting quality of care and support during the final days.
Too often the curative focus of modern medicine regards any death as a failure. Death, it is often said, is the final taboo of the 20th century. As we enter a new century, it is time to break the taboo and to take back control of an area that has been medicalised, professionalised and sanitised out of everyday experience.
The themes of control, autonomy and independence were recurrent throughout the work of the health and care group. We recognise the centrality of such issues to the lives of older people; the wish to retain control is a powerful motivation, and there is no reason why this should change as the end of life approaches.