We need a completely new approach to caring for older people

Someone retiring tomorrow could expect to live another two decades - but will they be good years?

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Robert Louis Stevenson wrote:  “There is only one difference between a long life and a good dinner: that, in the dinner, the sweets come last.”

Long life was a dream for many in Stevenson’s time – as indeed was a good dinner. These days, with life expectancy for men in the UK nudging 80 and for women over 82, it’s the norm. If the historical trends continue, someone retiring tomorrow could expect to live another two decades on average. But will they be a “good” two decades? Will we enjoy the sweets at the end of our meal?

The truth is that old age brings a great deal of uncertainty. We know it brings a reduction in activity, a reduction of both physical and cognitive functions  and a greater dependence on someone to help you do the things you used to do for yourself – from cooking to getting around to even going to the lavatory. But we are only just learning about how fast some people’s lives changes, why they change and importantly, how we as a society need to adjust to help people enjoy their later years.

Supported by the AXA Research Fund, I have been working on a study, the Newcastle 85+ Study, of over 1000 individuals born in 1921 and registered with GPs in the local area, and this is augmenting an increasing body of research going into the issue of healthy ageing. One thing this work is telling us is that the structure of how we care for the older people in our society needs a radical rethink.

For example, GPs surgeries are set up for an individual to see the doctor with one complaint and be treated in an average of seven minutes. In the 85+ study we looked at 18 chronic diseases – from hypertension to dementia. None of our cohort was free of any of these complaints, and the average number of diseases was four for men and five for women.  Interestingly some of these diseases can directly feed the development of others – there is a direct link from hypertension to dementia for example. How can you treat four or five often interlinked problems in a seven minute consultation? This has major implications for the NHS, but also for health insurers and pharmaceutical companies.

It’s not just the NHS that needs to change. Caring for older people needs a completely new approach. As people age, it becomes harder for them to perform daily functions, from cutting their own toenails to light housework, to getting dressed or feeding themselves. And eventually many will need carers, whether they come from local authorities or from their own families.

Two major issues have emerged. We found that the main carers of the people in our study were their children who were themselves around 60 years of age. These are more likely to be women. Like everybody, these people will be required to work longer to fund their retirement. Regardless of whether they are men or women, if they are in full time employment and caring they are two or three times more likely to report ill health.

The other issue is that the onset of increased disability is predictable – we first have difficulty cutting our toenails and shopping and the last function we lose is to feed ourselves. Eventually we deteriorate more rapidly as one problem compounds another. At present local authorities provide services for the more critical cases – which is understandable as the need is obvious. But providing some element of support earlier could slow the development of more critical problems later. The Care Act may force councils to focus on earlier action, but with limited budgets and resources, the money we fail to spend now will bring greater misery and cost in the future.

Back in 1997, the then Director General of the World Health Organisation, Hiroshi Nakajima said: “Increased longevity without quality of life is an empty prize.” He should know. Japan has the longest life expectancy in the world and is  putting a great deal of investment and effort into promoting healthy old age and ensuring all people in Japan, regardless of where they live and what their background is or personal circumstances are, benefit equally.

By contrast in the UK there is a shocking discrepancy in the number of healthy years lived at age 65. If you are in the South East of England, you are likely to have at least eight more years of life free from disability than if your home is in the North East.

Why is this? Social class and education are undoubtedly contributing factors but others that we might be able to address today are critical – smoking, drinking and activity, both mental and physical. Cutting down on drinking and smoking, walking the dog, filling in crosswords - these can all help you have a healthier old age and postpone the onset of chronic diseases such as dementia.

We all enjoy a good meal and we all would like to enjoy a good life. Yet to enjoy our old age we need to think urgently about how we care for the elderly, how we treat their illnesses and how we live our lives. The sweet at the end of our lives is, if you forgive the pun, our just deserts.

Professor Carol Jagger is AXA Professor of Epidemiology of Ageing, Newcastle University

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