21st century health services for an ageing population: 10 challenges for general practice

Abstract

![][1] When Queen Elizabeth II was crowned in 1952, life expectancy was 66 years for males and 71 years for females. By 2001, these figures were 77 and 81 respectively. Average life expectancy at 70 is already 17 years for males and 19 years for females. Old age is often caricatured as a time of ill-health, loneliness, unhappiness, and dependence, but life satisfaction peaks in the 70s and most over-80s rate their health as being good or excellent and say they do not live with life-limiting long-term conditions (LTCs). Most over 65s are neither disabled nor dependent.1 Despite this good news, ageing does pose significant challenges to health and social care systems, which need to change to meet radically different patterns of demand. I believe there are at least 10 key challenges for general practice in providing care for an ageing population. Several are well-illustrated by articles in this welcome themed issue of the BJGP . In England, people over 65 years comprise 46% of spend in acute care, 37% in primary care, 60% in social care, 60% of admissions, and 70% of bed days in hospital. Many older patients have complex needs or use multiple services. There is major unwarranted variation between primary care trusts in rates of emergency hospital admission or bed utilisation in over 65s; and in a range of disease-specific processes and outcomes.2 We need to focus more on older people with multiple morbidities, whose care should be more prominent in plans for service redesign. Older patients often get a poor deal in the NHS and other systems relative to other age-groups.3 Common age-related conditions receive lower priority and older people receive generally lower quality of care than those in midlife with the same diseases. Frailer old people who present with so-called ‘non-specific’ or … [1]: /embed/graphic-1.gif