Primary Care for Older People

Abstract

During the past century the UK has experienced a major demographic shift as people have lived longer. The proportion of the population over 60 is now 20%. By 2025 the number of people over 80 will increase by almost half and the number over 90 will double. These changes will have profound implications for provision of health and social care, particularly at primary care level, the site of most healthcare. Already 40% of the National Health Service budget and 50% of the social care and social services budget is spent on the over-65s. This is the background against which Steve Iliffe and Vari Drennan, experienced in general practice and community nursing, respectively, review the subject. They take us from the establishment of the NHS in 1948, through various organizational changes, to the current state with the advent of primary care groups. Although they make clear that this is not a textbook of geriatric medicine, they touch on the important causes of morbidity, mortality and disability in this age group. Where possible the authors base the text on their personal research. For example, Iliffe highlights the 75-and-over screening programme on which he did seminal work in the 1990s. The discussions are well referenced and have an international perspective. But I do have some criticisms. More could have been said about the implications of demographic change in different ethnic groups—especially since there is a widespread, and false, assumption that elderly people from minority groups will have supportive extended families. Also, the authors could have said more about the housing needs for long-term care of the elderly. But in general I recommend this latest addition to the Oxford General Practice Series.