A new concept in later living
Following publication of chief medical officer Professor Chris Whitty’s report on Health in an Ageing Society, Riverstone wellbeing director Dr Zoe Wyrko explores how we can offer a new concept in later living
In his 2023 chief medical officer’s report, Professor Chris Whitty chose to focus on acknowledging how successes in modern medicine have led to so many more people living a longer life, but also how many of these extra years can be a time of challenge and decline. To those of us working in the health and social care space, there is unlikely to be much in the report that comes as a surprise, but to have our everyday issues acknowledged in such a high-profile way is certainly refreshing.
Choosing to concentrate on topics which are about improving the quality of life, talking about health span rather than lifespan, and calling out the relentlessly negative portrayal of older age means that this document is our call to arms. Finally, someone is listening, so how can we make the most of this moment in time?
During my years as a geriatrician in the NHS, I found myself drawn towards the most vulnerable group of older adults, those living with frailty. Almost without exception, it was possible to see where things had started to go wrong for that individual, where if a certain intervention had taken place, or a level of support could have been provided, they would never have entered the cycle of decline which had led to them coming under the care of me and my specialist team in the Emergency Department of the local hospital.
My frustration with the system was exacerbated by the increasing amount of research showing that frailty can be treated and even prevented with the right intervention at the right time. And the intervention? A comprehensive multidisciplinary assessment looks at the whole person and takes into account what matters to them, followed up with a personalised action plan. No fancy medical gadgets, but expert professionals who have the time to understand the person, and who genuinely care about them and what happens to them.
I talk to a lot of older people about dying and, on the whole, it’s not death that frightens them – it’s the bit that might happen between them being the person they recognise as themself, and the end. In other words, it’s frailty that scares them. We now need to start talking about this decline not being inevitable, and about how it’s never too late to start making changes to live better and be stronger, regardless of age or existing medical conditions.
There’s strong evidence that a Comprehensive Geriatric Assessment (CGA) taking place during a hospital admission leads to more people being alive and living in their own homes within a year of hospitalisation.
We don’t yet, however, have the supporting evidence for the same benefits when a person is living in their own home (whether a house, retirement community or care home). This isn’t because we think it doesn’t work (we know it does), but rather because it’s just incredibly difficult to measure and research. We’re all confident of the benefits that our programmes have on the older adults that we work with; we’ve seen people feel better, move more, and get stronger with even relatively light touch interventions. Let’s take advantage of the momentum being generated by the chief medical officer’s report, start talking about quality rather than quantity, and how everyone can keep really living in their later years.
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