Aging population could overwhelm UK community care provision

The rapidly expanding elderly population is having an increasing impact on healthcare resources, with clinicians facing ever more patients with multiple chronic conditions. Over the coming months, MedWire will post a series of articles exploring the issues arising for elderly cardiac, cancer, and dementia patients, and the physicians who treat them.

Opening the series, MedWire reporter Mark Cowen speaks to Dr Helena McKeown about her concerns about the provision of community care for elderly people at a time of unprecedented population aging.

Dr Helena McKeown is chairman of the British Medical Association (BMA)'s Committee on Community Care, Dorset representative on the BMA's General Practitioner's Committee and a general practitioner from Salisbury in Wiltshire.

The latest United Nations (UN) report on World Population Aging (2007) states that the human race is now in a situation “without parallel in the history of humanity.”

A population ages when increases in the number of elderly people - those aged 60 years or older - outstrip those of children and people of working age.

The UN report shows that, worldwide, the population of elderly people is growing at a rate of 2.6% per year, whereas the population as a whole is increasing by just 1.1% annually.

Globally, the number of elderly people is expected to exceed that of children for the first time in 2047. In developed countries, where population aging has been accelerating since the nineteenth century, the number of children dropped below that of elderly people in 1998.

Indeed, in developed countries, more than 20% of the population is currently aged 60 years or older, and, by 2050, more than 30% of the population in these countries is expected to be in this age group. By around 2050, countries in the developing world are expected to reach the same stage in the process of population aging as those in the developed world are at now.

“There is a feeling among doctors that we, as a society, don't value older people enough, and we want to get our population debating how much we are prepared to invest in the facilities to look after older people in this society.”

These unprecedented major demographic changes have significant implications for society and the way in which governments tackle the challenges posed by an aging population, not least in the area of healthcare.

A recent 2008 survey by the British Medical Association (BMA)'s Health Policy and Economic Research Unit revealed that many of its members are concerned that current healthcare services for elderly patients are not adequate to meet the needs of an aging population, particularly in the area of community care.

McKeown says: “There is a feeling among doctors that we, as a society, don't value older people enough, and we want to get our population debating how much we are prepared to invest in the facilities to look after older people in this society.”

An increase in average longevity does not necessarily mean that these extra years of life will be spent in good health, she explains. Indeed, an increase in life span means that many more people will be living with diseases associated with old age, such as dementia, arthritis, cardiovascular conditions, and vision and hearing loss.

“In my own practice in Salisbury, we're seeing not just an increase in people over the age of 60, but also an increase in those over 75 and over 90. Indeed, I have a growing number of patients over 100 years of age. If you are over 100, you are going to need care,” says McKeown.

In the UK, the current emphasis on providing community care for elderly people in their homes, rather than in residential care, for as long as is safe and practical, means that the necessary resources need to be available to provide such care.

“This is an issue that really concerns me as a GP [general practitioner],” says McKeown. “Many GPs are pragmatists, we want to solve problems, but what we don't have are the solutions and the resources in the community to care for these individuals.”

She adds: “The funding of community services has not kept up with society's desire for people to stay in their homes for as long as possible. People deserve to have an old age that is fulfilling and dignified, at the moment I don't feel a lot of them are getting that.”

McKeown acknowledges that new technology and telecare - the remote monitoring of patients in their homes - have important roles to play in providing care for elderly patients in the community, but adds that “it doesn't replace human contact” and the problems of isolation.

“We no longer have an attached social worker, a community physiotherapist or a dedicated community psychiatric nurse so it's very difficult to give our patients the sort of joined-up care they need,” she says. “It's incredibly frustrating for everyone involved - all we want to do is help our patients and we can't.”

GPs in the UK are in an ideal position to provide care for elderly people in the community as they have often known their patients for a long time and are familiar with their specific healthcare needs, she explains. However, the current move toward market-driven healthcare in the UK in an effort to improve care standards may actually have the opposite effect, she says.

“It is wonderful that our healthy lives are being extended but we still have this period at the end when we are likely to be sick and needy. That means addressing the financial cost, but it also means address the issue of an aging population in a very innovative, progressive way.”

“If you keep privatizing and separating, using market forces to divide up and apparently increase quality of healthcare, you are going to cause problems with little bits of care and not have any continuity, says McKeown.

“The market-driven improvement in healthcare, if you believe it is working in improving healthcare, is exactly the opposite force to what we need regarding an increase in the elderly population.”

She adds: “A recent publication by the Health Policy and Economic Research Unit at the BMA, which I co-authored, says that market-driven healthcare is against what we actually need, which is a joined up approach and a culture of collaboration between healthcare providers.”

Indeed, the report calls for a redeployment of human and financial resources in health and social care to meet the needs of an aging population, particularly as elderly patients are frequently admitted to hospital not because of a medical problem but through a lack of social and domestic support.

“Unless this is tackled, it will remain a key barrier to improving the lives and clinical management of those living with long-term conditions,” says the report.

McKeown concludes: “It is wonderful that our healthy lives are being extended but we still have this period at the end when we are likely to be sick and needy. That means addressing the financial cost, but it also means address the issue of an aging population in a very innovative, progressive way.

“Things are going to get worse unless we get our act together very quickly. Addressing the healthcare needs of an elderly population should be a top priority for our government, and should be a top priority for the European government.”

Web Links:

United Nations report on World Population Aging (2007)
BMA survey report of members' views on care of the elderly 2008 (pdf)
BMA report 'Improving the management of long-term conditions in the face of system reform (pdf)