We must adapt for an ageing population says Chief Medical Officer

• Successive governments and professional bodies have not recognised the degree to which the population living in older age is concentrating geographically
• The rise of multiple conditions in the same older person (multimorbidity) requires changes in medical training, NHS services and research

The fact that people are living longer compared to a century ago is a triumph of medicine and public health but an expansion of the period in ill-health is not inevitable.

England’s CMO Professor Chris Whitty, in his annual report published today (Friday 10 November 2023) says we need to focus on how to maximise the independence and minimise the time in ill-health between reaching older age and the end of their life. Quality, enjoyment and independence should be the principle aims.

The report, Professor Whitty’s fourth as CMO, describes how we can maintain older people’s independence via two broad complementary approaches:

*Reduce disease, to prevent, delay or minimise disability and frailty *Change the environment so that people can maintain their independence longer

The geography of older age in England is already skewed away from large urban areas towards more rural, coastal and other peripheral areas, and will become more so. Efforts to achieve shorter periods in ill-health and an easier environment for those with disabilities, should concentrate on areas of the country where the need is going to be greatest.

The report makes the case that older people are currently underserved in health care, with less accessible transport links and insufficient infrastructure designed for older adults, including housing. Providing services and environments suitable for older adults in these areas is an absolute priority if we wish to maximise the period all older citizens have in independence.

The report calls for research into multimorbidity, frailty and social care to be accelerated, and states that the medical profession needs to focus on maintaining generalist skills as doctors specialise.

Medical specialisation, specialised NHS provision, NICE guidelines, and medical research are all optimised for single diseases but that is not the lived reality for the great majority of older adults who often transfer very rapidly from having no significant disease states, to several simultaneously. The increasing specialisation of the medical profession runs counter to optimising treatment for this group of largely older citizens and patients.

Professor Chris Whitty, Chief Medical Officer said:

Maximising the quality of health in older adults should be seen as a major national priority - we can make very significant progress with relatively straightforward interventions. Older people can and should be better served.

We need to recognise and reflect in policy and medical practice where older people are concentrated geographically, increase clinicians’ generalist skills, improve mental health provisions and make it unacceptable to exclude older adults from research because of older age or common comorbidities.

Greg Fell, President of the Association of Directors of Public Health, said:

Today’s report from the CMO clearly sets out how important it is that, as a society, we work together to create healthy spaces and places to live and work in. Only by ensuring that people have access to the things that support us to thrive – like good housing, good work and green spaces – can we ensure that people will continue to enjoy good health and wellbeing as they get older.

Directors of Public Health and their teams work in partnership with both local authority colleagues and the voluntary and community sector to help create these spaces, with health and wellbeing at their heart, so that as well as living for longer, people are also living healthier, more fulfilling lives.

Professor Dame Carol Black, Chair of the Centre for Ageing Better, said:

We welcome the Chief Medical Officer’s new report and its focus on the diversity of experiences in older age. Older generations are repeatedly grouped together as a homogonous group, when in fact many people are facing enormous challenges and hardship in their later years, as this report makes clear.  

Good health has an enormous influence on people’s enjoyment of later life but we don’t all have an equal opportunity to age well. Wealth, work, housing, discrimination; all play a significant role in the huge gap in healthy life expectancy between the richest and poorest areas of the country.     

We also echo the report’s message that we need to aspire to improve the quality of life for people as they age, including through creating homes and communities that help people to age well. This will not only benefit millions of individuals but also deliver massive societal benefits if more people are given the opportunity to make the most of their later life. 

Professor Dame Linda Partridge, Biological Secretary and Vice President, The Royal Society and Professorial Research Fellow, University College London, said:

Supporting an ageing population to live well for longer will be a defining challenge of the 21st century, for the UK and many other economies. This timely report from the Chief Medical Officer serves to bring these issues to the forefront of political and public discussion. Among the many facets of this challenge, the emerging field of geroscience holds promise for managing and preventing some age-related diseases. Capitalising on this promise will require new treatments and an evolution of approaches across the whole life sciences system, from fundamental discovery to trial design.

Dr Sarah Clarke, president of the Royal College of Physicians, said:

With an increasing number of people with multiple long-term conditions, generalist skills are key, as are close working links with primary, community care and the voluntary sector. It is vital that specialists are supported to feel confident in their generalist skills, to provide joined-up care for these patients.

Professor Adam Gordon, President of the British Geriatrics Society, said:

Population ageing is one of the biggest opportunities and challenges facing us globally. With this in mind, we welcome that this year the Chief Medical Officer has chosen to focus his annual report on the ageing population. We agree that people living longer lives is a triumph of public health, modern medicine and healthier lifestyles.

The invaluable contribution of older people to society enriches us all. The Chief Medical Officer is also right to highlight the challenges associated with more people living with complex health and care needs, including increasing levels of frailty and multimorbidity. Inequalities are increasing across our society, with some people enjoying excellent health into their later years and others spending many years living in poor health. There are not enough specialists working in older people’s healthcare and not enough healthcare professionals have developed the right skills to care for this growing population group.

The Chief Medical Officer’s call to recognise this as a major national priority is very timely – we are all ageing and we must act now to grasp this opportunity, ensuring that older people now and in the future are enabled to live healthy, independent lives for as long as possible.

Background information:

The CMO’s annual report last year was on air pollution, while his report in 2021 looked at health in coastal communities. The 2020 annual report looked at health trends and variation in England.

The report demonstrates how the rate of population ageing varies across the country and includes a chapter with contributions from 7 different local authorities: Hampshire County Council, Isle of Wight Council, Gloucestershire County Council, Cumberland Council, North Yorkshire Council, Derbyshire County Council and Norfolk County Council. For each of these, the Director of Public Health describes the opportunities and challenges of a rapidly ageing population in their local authority.