It comes as no surprise that we are living longer. As government strategies have improved living and working conditions, mortality rates have ultimately been reduced. Community measures such as the national immunisation schedule, population screening and health education have all played a role in increasing life expectancy overall.
According to World Health Organisation statistics, the average life expectancy for someone born in the UK in 1990 was 76, increasing to 81 in 2013.
This trend is replicated globally, however the largest gains in life expectancy have been achieved in low-income countries. Zambia is an example of this, with an average increase of 15 years within the same timeframe.
In the UK, the number of people aged over 65 years has increased by approximately 1.7 million people, and by 2035 it is predicted that this age group will make up 23 per cent of the total population.
Increasing the lifetime of individuals globally is one of the 20th century’s greatest achievements. However, this shift in demographics means healthcare professionals are confronted with a changing landscape of chronic diseases. Elderly patients have complex needs, both biological and social in nature.
One of the key challenges facing healthcare professionals is dealing with the rise in prevalence of chronic diseases: such as diabetes, heart disease and arthritis. These are difficult to manage as these illnesses often overlap, with patients suffering from a combination of diseases and risk factors. Alongside the higher rate of physical diseases, the elderly are also vulnerable to conditions affecting their ability to self-care.
Dementia is a major issue. With almost 4,000 diagnosed cases in Cardiff alone, this progressive disease can place stress on not only patients, but also their families and those involved with their care. Patient autonomy is compromised as communication is often impaired. A thorough evaluation of capacity is required to determine the patient’s ability to consent to treatment. The memory problems associated to dementia can also serve as a challenge as often patients live alone, and require carer support.
Often multiple systems are involved in a disease process, which makes drug interactions, or polypharmacy, more likely. Doctors must therefore be more careful in the drugs they prescribe and the doses required. This is especially true of those suffering with kidney disease, affecting older populations much more. One of the core duties of a doctor is to do no harm (non-maleficence) therefore it is important that side effects are monitored with vigilance.
The elderly generation access healthcare services more than other age group. With more hospital admissions, outpatient visits and GP appointments, it’s not surprising that the majority of the healthcare budget is spent on care of the elderly. John Appleby, from the King’s Fund charity in London, suggests that actually the ageing population do not demand more medical care resources in particular. Instead, it is the social care costs which are contributing to the escalation in spending overall. He believes the lines between social and medical care are “blurred” and often overlap, as a great deal of modern medicine focuses on how to safely bring patients back into the community.
The discharge and care planning process is much more complicated in older generations. Often the reason behind an extended hospital stay is a complex social situation, and not necessarily the consequence of medical conditions. In these cases, discharge is not deemed to be safe and is frequently delayed whilst awaiting evaluation from occupational therapists, physiotherapists and social workers. This is partly due to the elderly being at an increased falls risk due to mobility problems, in which discharge would not be safe without home adaptation.
Alongside the physical and social problems, the elderly are known to be a risk group for developing depression and other psychiatric disorders In Wales, approximately 15-30 per cent of those aged 65 and over have some form of depression. This figure rises up to 50 per cent in those who are hospitalised. This is partly due to a higher prevalence of chronic diseases, often a source of pain and stress. It is also linked to loneliness and isolation. Approximately a third of elderly people in the UK describe themselves as “lonely”. Some illnesses themselves such as Parkinson’s disease and dementia may manifest with depression as a symptom. Care of the elderly is multifaceted, requiring the balance of attention to many co-morbidities and social situations. Mental health is not bought into the focus of care because of these factors, and may be neglected.
But the question remains. Why is it so important that we look after our ageing population? In a 21st Century Britain, many in this age category wish to continue to participate in their community, politics and economic affairs. According to Age UK, more than half of the people in the 65 plus category take part in volunteering or community help roles.
With this in mind, perhaps a different approach to the elderly is needed. To do this there needs to be a change in attitude. Improving their health enough to allow integration into the community requires a holistic approach. This would require the collaboration of healthcare providers, community services, families and policy-maker expertise.
Caring for the elderly population is seen not only as a responsibility, but can also bring various positives. Statistics from Age UK report that rates of employment in the 65 plus age group are rising. Approximately £50 billion is saved per year in childcare costs, enabling the working generation to raise a family and continue with their career paths respectively.
It is not only in their best interest, but in the interests of the nation as a whole to promote good health in the ageing population. The life expectancy is still rising. What good is prolonging life if the infrastructure to care for these people does not exist to ensure a good quality of life?