11.7 Health of older people
Declines in death rates and fertility have resulted in population ageing and an associated epidemiologic transition from infectious to chronic diseases. Dramatic improvements in life expectancy have occurred, although these have not been equally distributed among socioeconomic groups or seen in politically or economically unstable countries. Ageing is associated with increased health- and social-care needs, not only due to increased risk of chronic diseases but also due to multiple pathologies, and ironically, greater risk of iatrogenic problems associated with polypharmacy. Measures of functioning and disability provide a comprehensive and pragmatic means of assessing older people’s needs and evaluating the effects of interventions. Older people are capable of benefiting from a wide range of preventive interventions that reduce mortality and morbidity in middle age—such as cardiovascular disease (CVD) risk factor reduction, increased physical activity, and a healthy diet. Specific preventive interventions—such as falls-prevention schemes and screening or anticipatory care—are probably of less value than was thought, which may reflect the increased access and acceptability of high-quality health services for older people in many high-income countries. These include disease-specific services—such as stroke units, orthogeriatric units, and psychogeriatric units—and general services such as assessment and rehabilitation units, day hospitals, and long-term care. Many countries, particularly low- and middle–income ones, have yet to establish these essential requirements for meeting older people’s needs. Informal family support remains the backbone of care for older people in all countries, and without these contributions, statutory formal health- and social-care sectors would be inundated. The costs of care are wrongly considered to increase with age; in reality, costs are more strongly concentrated in the short period before death. Long-term care in institutions is expensive, and reducing the need for such care by increasing home care and avoiding the use of acute-sector institutions are both important measures for reducing costs. Considerable debate is required in order to develop new policies on societal and individual responsibilities for meeting the costs of long-term care. Public health has responsibilities for monitoring trends and transition in risk factors, disease, and disability in ageing populations. In addition, it has roles in encouraging effective health-promotion practices and in setting policy for the equitable and efficient use of health-care resources for the growing population of older people.
