Meeting the needs of an ageing world

There are more older people on our planet than at any other time in history. With that comes a major burden on healthcare. How can we best address the healthcare needs of the elderly population? Sarah Harrop takes a look.

The world’s population is getting older. According to Our World in Data, in 2018, the number of people worldwide older than 64 actually surpassed the number of children under five years old for the first time in history.

While these demographic changes are a worldwide trend, the timing of this crossover has varied significantly between countries – in America, for example, under-fives were outnumbered by over 64s as early as the 1960s, while in South Korea, this didn’t occur until 2000, and in low-income countries like Nigeria it’s yet to happen. However, data shows that overall, the number of children under five years old has peaked and is projected to plateau, then fall, for most of the 21st century.

“As the global population of people older than 64 years will continue to grow, it's clear that we're moving towards an aging world,” say Our World in Data’s Hannah Ritchie and Max Roser. 

What are the challenges of having more elderly people?

While increasing life expectancy is, of course, a good thing, on the other side of the coin the population ageing is a considerable burden on healthcare systems and health care services.  

To give an example of the scale of the issue, when the NHS was founded in the mid-1940s, one in every two people died before the age of 65. Today, fewer than one in seven die before their 65th birthday. In 2023 there were 11 million people aged over 65 in England, with that figure set to rise 30.5% by 2043. The over-85s, the population demographic in England in greatest need of health and care services, is set to grow by 10% by 2043, according to Age UK figures.

In Japan, the situation is more extreme: one telling fact is that in 2011, sales of adult nappies for incontinence in the country had exceeded sales of baby nappies. Japanese nappy manufacturer Oji has even recently announced that it would stop producing nappies for babies altogether and focus on the market for older adults, due to Japan’s ageing society and declining birth rates.

All of this highlights the fact that the health needs of older people have never been greater. What is more, longevity does not necessarily mean healthy ageing. Evidence suggests that the proportion of life in good health has remained broadly constant, implying that the extra years we’ve gained are lived in poor health, says the World Health Organization (WHO).

According to a review article published in The Lancet Public Health, the age-related disease burden (ie the amount of disease in elderly people) accounts for over half of the total disease burden across the world (51·3%).

What kind of health problems are linked with old age?

As we age, certain health conditions and diseases become more common. These include:

• Chronic disease, such as diabetes, chronic obstructive pulmonary disease (COPD) or arthritis
• Chronic conditions like high blood pressure
• Bowel and bladder problems such as urinary incontinence or infections
• Dementias, such as Alzheimer’s disease
• Mental health problems such as depression and anxiety
• Hearing and vision problems, such as cataracts
• Osteoporosis
• Shingles, influenza, COVID-19 and other infections.

Complex and interacting health conditions emerge in later life, too, often requiring a cocktail of different medicines, community-based and long-term care, specialist care facilities, social care and help with daily living.

“Older age is also characterized by the emergence of several complex health states commonly called geriatric syndromes. They are often the consequence of multiple underlying factors and include frailty, urinary incontinence, falls, delirium and pressure ulcers,” says the WHO.

Meeting the healthcare needs of an ageing population

Part of the problem with addressing the health challenges of a burgeoning elderly population is that we currently just aren’t set up for it.

Across the world, healthcare systems are geared towards treating acute illnesses and aren’t well adapted to dealing with long-term (chronic) diseases and disability.

That means that the needs of older people with several chronic diseases (so-called ‘multi-morbidity’) aren’t being met, running the risk of their health deteriorating further and healthcare costs racking up.

“Developed countries are struggling to control the costs of healthcare while providing for the increasing demands. The traditional model based on institutional care is neither appropriate nor sustainable given the evolving and growing needs of the population,” says a review paper in the Canadian Journal of Geriatrics.

Therefore, some potential strategies being considered by policy-makers to better address the needs of the ageing population include the following.

Primary prevention

“A long-standing aim of national health policy is to move more care out of hospital and into the community. Underpinning this drive is the desire to reduce the need for more expensive and higher risk treatment in hospital, which can happen when someone is admitted as an emergency following a crisis,” says a 2019 Age UK policy position paper on improving healthcare in England.

Better primary prevention here in the UK would therefore involve transferring funds and resources into primary care and community-based care providers, both supporting caregiving by family members and improving access to primary healthcare.

It will only be possible to achieve significant reductions in admissions by reducing the need for care in the first place, the authors go on to say. That means investing in community and primary care services. Older people frequently report problems accessing GP services, for example, and this is even more difficult for care home residents who may have little control over when and how they see their family doctor.

“The NHS must seek to strengthen the breadth and availability of community services and focus on maximising overall health and wellbeing, rather than predominantly responding to individual crises as they occur,” Age UK adds.

 Tackling frailty

In gerontology, frailty refers to people whose low physical reserves make them more vulnerable to even relatively minor shocks to their health. Not all older people are frail, but it mostly affects people in later life: around 12 per cent of people over 65 increasing to 25 to 50% of the over 85s, according to Age UK.

Research carried out by the charity has shown that the types of care offered for people who are frail might not reflect a proper understanding of what works or what is possible.

If healthcare professionals don’t take frailty into account, it can lead to worse health outcomes and even shorten a person’s life, leading to muscle wastage, lower resilience and exposure to infections, falls and other risks. That is bad for older people, as well as being an inefficient use of precious resources. Instead, frail elderly people should be supported to build their overall resilience and prevent shocks and traumas.

“Older people living with frailty must be able to expect care that is targeted, planned, and wherever possible based on the goal of improvement rather than just maintenance. They should also expect that it will be incorporated into other treatments they may be receiving. For example, for someone receiving surgery, an assessment and care plan that targets frailty reduces the risk of complications by up to 80%,” says Age UK.

“Getting health care right for older people means getting it right for people living with frailty – avoiding poor health in the first place; planning and joining up care when needs do arise; and getting people on the right pathway of care when crises occur.”

 Reducing inequalities 

Living a longer life brings opportunities both for the older population and for societies as a whole, leading to greater wellbeing and quality of life. Those extra years might allow people to pursue further education or a different career and contribute to families and communities, for example.

There is no such thing as a typical elderly person. Some 80-year olds have similar mental faculties and agility as many 30-year-olds, while the health of others declines steeply as early as their 60s.

But this variation isn’t random. Much of it comes from our physical environment and socioeconomic status. That could include the communities and family we were born into, our sex and our ethnicity and how this alters behaviour and the opportunities that are available to us. Therefore, policy, interventions and initiatives to promote healthy ageing should also aim to tackle inequalities, says the WHO.

Attitudes to older people among public health professionals and society as a whole also need an overhaul, with older people often assumed to be frail or dependent and a burden to society. Such ‘ageist’ attitudes can lead to discrimination as well as affecting the way in which policies are developed and older peoples’ chances of enjoying a healthy old age.

Tailoring physical and social environments to allow older people to do what is important to them despite loss of capacity is important, too. For example, that might include safe and accessible public transport or public buildings.

In response to these challenges, the WHO is leading roll-out of the UN Decade of Healthy Ageing 2021- 2030, which wants to reduce health inequities and improve the lives of older people, their families and communities through collective action in:

• changing how we think, feel and act towards age and ageism;
• developing communities in ways that foster the abilities of older people;
• delivering person-centred integrated care and primary health services responsive to older people; and
• providing older people who need it with access to quality long-term care.

Play your part in promoting healthy ageing

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