Health in 2040: what will increasing illness mean for older people's lives? Q&A with Tom Gentry, Age UK

What do the projected increasing rates of illness mean for older people’s lives? 

Living with any long-term condition is significant, but I think the multi-morbidity that's going to come with these projections is arguably the greatest challenge. People will be living with multiple conditions that can all cascade into crises as they get older, especially as care for different conditions isn’t particularly well joined up.  

Issues with mobility, hearing loss and cognitive decline will be having an impact at the same time as the increasing prevalence of illnesses mentioned in the report like cancer, type 2 diabetes and kidney disease. That’s more people who are going to reach older age with clinical frailty, giving them lower health resilience and putting them at higher risk from even quite minor shocks and falls. 

Looking at the projections in our report, what are you most concerned about and why?  

We know people are living longer and are likely to experience illness as they get older. But it’s the scale of the predicted growth in illness that’s most startling.  

Our own recent report into the state of health and care for older people highlights how our health and care system is already struggling, and too often failing, to meet the needs of our growing older population. There’s an over-reliance on acute hospital-based care and not enough focus on prevention and early intervention to enable older people to stay fit and well in their own homes, and in care homes. 

What tangible things can people in power do now to improve the lives of people living longer, and potentially with major illness, in the future? 

I think preventing frailty is going to be a key part of the support older people will need, and frailty must be considered as part of the bigger picture of how we treat major conditions in older age.  

Some great initiatives – including work by the Centre for Perioperative Care, the Joint Collegiate Council for Oncology, and the POPS (Perioperative medicine for older people having surgery) project at Guy’s & St Thomas’ NHS Foundation Trust – have sought to build frailty into treatment pathways, giving people a better chance of successful outcomes from surgery, or offering alternative interventions, more appropriate interventions for their levels of physical resilience. Expanding those approaches will be critical in the future.  

We also need to make care more joined up and proactive for older people. Our own research shows that the number of people who feel supported in managing their long-term condition has been declining for the last few years.  

We agreed with many of the recommendations in the Fuller Stocktake of integrating primary care. We need primary care services that can both deliver immediate care and be more proactive about working alongside people to manage long-term conditions in a way that really makes a difference to them. Whether that’s via direct support or being a conduit to other health, voluntary or community services that can help.  

If you invite people with high needs in for an assessment, you can do simple things like review medicines, assess their risk of falls, make referrals, and plan a holistic care package around their individual goals and needs. This could be about improving mental health, reducing loneliness, living independently, self-care, all things which if focused on in a sustained way, can help to avoid future crisis situations that would lead to a stay in hospital.  

In many ways using older people as a starting point is a great model for designing better joined up care. Often older people are seen as a separate group because their needs are so complex. But the approach that’s needed – to build a service that can assess multiple physical, mental health, and environmental needs and create a plan for proper joined up care provided across multiple agencies – that’s something that will ultimately work well for anyone.  

What else do you think needs to be in place to support people to live well for longer? 

One of the things that often gets brushed over when we talk about the future older population, is that every single one of those older people is already alive right now. I think it’s important to note that these are projections based on not doing enough in the first place. We’ve still got time to prevent a lot of those things from happening.  

We obviously need to be looking at the big society-wide picture when it comes to prevention – it’s multifaceted.   

And of course, we preface everything we say about what’s needed in the NHS with ‘you have to solve the social care issue’. Talk always turns to money when we talk about social care, but really we should be asking what sort of health and care system we want to provide. One that doesn’t intervene too late, that doesn't just kick in when someone is way past the point at which you could have provided a much cheaper intervention. But instead one that’s focused on maintaining a person’s ability to live well. That has to be the starting point.  

This content originally featured in our email newsletter, which explores perspectives and expert opinion on a different health or health care topic each month.