The chief medical officer’s annual report says we can improve older citizens' quality of life, and this should be a major aim of policy and medical practice.
The fact that people are living longer compared to a century ago is a triumph of medicine and public health. But, an expansion of the period in ill-health is not inevitable.
Chris Whitty, England’s chief medical officer (CMO), in his annual report published on 10 November, 10, 2023, says we need to focus on how to maximise independence and minimise the time in ill-health between reaching older age and the end of their life. Quality, enjoyment and independence should be the principle aims.
The report, Chris’ fourth as CMO, describes how we can maintain older people’s independence via two broad, complementary approaches:
- Reduce disease, to prevent, delay or minimise disability and frailty
- Change the environment so that people can maintain their independence longer
The geography of older age in England is already skewed away from large urban areas towards more rural, coastal and other peripheral areas and will become more so. Efforts to achieve shorter periods of ill-health and an easier environment for those with disabilities should concentrate on areas of the country where the need is going to be greatest.
The report makes the case that older people are currently underserved in health care, with less accessible transport links and insufficient infrastructure designed for older adults, including housing. Providing services and environments suitable for older adults in these areas is an absolute priority if we wish to maximise the period all older citizens have in independence.
The report calls for research into multimorbidity, frailty, and social care to be accelerated and states that the medical profession needs to focus on maintaining generalist skills as doctors specialise.
Medical specialisation, specialised NHS provision, NICE guidelines, and medical research are all optimised for single diseases. However, that is not the lived reality for the great majority of older adults, who often transfer very rapidly from having no significant disease states to several simultaneously. The increasing specialisation of the medical profession runs counter to optimising treatment for this group of largely older citizens and patients.
Chris said, “Maximising the quality of health in older adults should be seen as a major national priority - we can make very significant progress with relatively straightforward interventions. Older people can and should be better served.
“We need to recognise and reflect in policy and medical practice where older people are concentrated geographically, increase clinicians’ generalist skills, improve mental health provisions and make it unacceptable to exclude older adults from research because of older age or common comorbidities.”
Greg Fell, president of the Association of Directors of Public Health, said, “Today’s report from the CMO clearly sets out how important it is that, as a society, we work together to create healthy spaces and places to live and work in. Only by ensuring that people have access to the things that support us to thrive – like good housing, good work and green spaces – can we ensure that people will continue to enjoy good health and wellbeing as they get older.
“Directors of Public Health and their teams work in partnership with both local authority colleagues and the voluntary and community sector to help create these spaces, with health and wellbeing at their heart, so that as well as living for longer, people are also living healthier, more fulfilling lives.”
Sarah Clarke, president of the Royal College of Physicians, said, “With an increasing number of people with multiple long-term conditions, generalist skills are key, as are close working links with primary, community care and the voluntary sector. It is vital that specialists are supported to feel confident in their generalist skills, to provide joined-up care for these patients.
Adam Gordon, president of the British Geriatrics Society, said, “Population ageing is one of the biggest opportunities and challenges facing us globally. With this in mind, we welcome that this year, the chief medical officer has chosen to focus his annual report on the ageing population. We agree that people living longer lives is a triumph of public health, modern medicine and healthier lifestyles.
“The invaluable contribution of older people to society enriches us all. The chief medical officer is also right to highlight the challenges associated with more people living with complex health and care needs, including increasing levels of frailty and multimorbidity. Inequalities are increasing across our society, with some people enjoying excellent health into their later years and others spending many years living in poor health. There are not enough specialists working in older people’s healthcare and not enough healthcare professionals have developed the right skills to care for this growing population group.
“The Chief Medical Officer’s call to recognise this as a major national priority is very timely – we are all ageing, and we must act now to grasp this opportunity, ensuring that older people now and in the future are enabled to live healthy, independent lives for as long as possible.”