As we all get older, do we have the doctors we need?

Not sure whether I have to declare an interest here: I’m writing about age and I am, after all, growing older.

On the other hand, so’s anyone who reads this. What’s more, that’s not just true of us as individuals but also of the societies we inhabit, at least if we have the good fortune to live in one of the wealthier nations. For instance, in Britain between 1901 and 2008, life expectancy grew by 32 years for men and 33 for women. Perhaps even more striking is the finding that life expectancy at 70 is 17 years for men and 19 for women.

Why do I know all this? Because I’ve been reading some articles by David Oliver. He’s the National Clinical Director for Older People’s Services in the English Department of Health and he takes positions on questions of ageing that are both refreshing and challenging.

For instance, he points out that ‘the constant public dialogue of population ageing as being a ‘timebomb’, ‘tsunami’, ‘burden’ or ‘crisis’ is unhelpful scaremongering which colours our attitudes to older people.’ Instead, we should be taking satisfaction from our success in extending life, and realise that it is because of that achievement that we have more older people around: in 1901, 5% of the population was over 65, in 2008, 19%.

There are of course challenges associated with this change, and Oliver delights in throwing down a few himself. Particularly to his own profession. At a conference attended by young or training doctors, he asked:

‘Who in the room wants to spend much of their career looking after people who can’t be cured of their long term conditions or disability, older people, including the ‘oldest old’, the vulnerable, the dependent, the demented and the dying?’

Strong words and one can imagine not many would hold up their hands. But to those who didn’t he had a stark message:

‘You need to get into paediatrics, maternity, a lab-based speciality or under 65 mental health/disability services.’ Or leave the profession. Or leave the country.

Healthcare is changing. We still have a specialty called ‘Care of the Elderly’ but you don’t have to be in it to be treating old, in some cases very old, people. 60% of hospital admissions in England are for patients aged 65 or over, 70% of the bed days are consumed by them. You may be in General Medicine, Rheumatology or Gastroenterology, but sheer demographics are increasingly making your case mix look like a Geriatrician’s.

But Oliver isn’t just saying, ‘that’s the way it is, live with it.’

He’s saying, ‘that’s the way it is, celebrate it.’

Which is good news for all of us when you come to think of it. After all, we’re none of us getting any younger.

Well may he smile: it's not all bad news

Healthcare: the kids are as bad as oldies

I was intrigued by an article I read recently by Denis Piveteau, a member of the French equivalent of the Supreme Court (the Conseil d’Etat) and also chair of the Commission into the future of health insurance in France.

We all know that one of the great issues of our time is the ageing population and the impact it has on health services. We all know that because it keeps being said. In the same collection as Piveteau’s paper, David Oliver from the Department of Health in England pointed out that ‘people over 65 account for 60 per cent of admissions, 70 per cent of bed days, 80 per cent of emergency readmissions or deaths in hospital and nearly 90 per cent of ‘delayed transfers of care’.’

But Piveteau recommends that we distrust simplistic soundbites. It isn’t just the old who consume healthcare services. He tells us that in France, at least, ‘people aged over 75 represent about a fifth of the total expenditure on healthcare of the population, or roughly the same as is consumed by people under 30, and those who are over 85 represent about the same as those who are under 10. And yet no one would ever think of claiming that people under 30 or under 10 are responsible for the deficit in health insurance in France’.

Now it’s true that the proportion of the population under 30 or under 10 isn’t growing, while the proportion over 75 or 85 certainly is. The ageing population is going to be a much bigger factor in determining the future of healthcare over the next few years than the younger age groups.

Even so, it’s great to have a little context, a little perspective. Expenditure on the very old is certainly high, but so is expenditure on the very young. We don’t resent the latter; it might not be a bad thing to be more tolerant of the former.

And that is the balanced view on an impartial observer of the human scene. Who, you may be surprised to learn, will be 60 next birthday.

You think we're the problem? Take a look at the kids.
And we don't make as much noise.