Prevention Not Cure – A Picture of Health for an Ageing Population
There is nothing like a crisis for generating opportunities for paradigm shifts.
In November, SAMI hosted a “Blowing the Cobwebs off your Mind” event, which looked at the future of the pharmaceutical industry. As the report shows, a central principle for the future was the need to engage people as partners in the upkeep and maintenance of their own health, “with an emphasis on ‘wellness’ and anticipatory interventions”. This emphasis is not only desirable: it is becoming a necessity.
Society is ageing. One in six people in England and Wales are aged over 65. By 2050 there will be just 3.9 working age people to each person aged 65 or over. And the oldest age groups are increasing at the highest rate. The number of centenarians in the UK is projected to rise from 12,640 in 2010 to 160,000 by 2040.
The ageing population will increase the demand for health and care services. Research commissioned by the Royal National Institute for Blind People (RNIB) and published in 2009 showed that, if nothing is done, the number of people suffering serious sight loss will increase by over 20% by 2020 and double by 2050, leading to greater demand for health and social care, greater co-morbidities – for example fractures due to falls, heart disease due to inactivity, and depression due to social isolation. All this as if blindness itself were not bad enough!
The implications for the UK’s health care systems are obvious. In 2010, the Chief Executive of the NHS in England challenged the NHS to find between £15-20 billion in efficiency savings and quality improvements simply to allow the NHS to absorb the twin pressures of demographic change, and the increase in new and high-cost treatments. Add to that the problem in finding the staff to care for the larger numbers of ill and dependent older people, and it becomes clear that change is a must.
Apart from the threat of step increases in the costs of health care, there are clearly huge benefits that come from older adults maintaining a healthy lifestyle. And there is evidence to support the cost-effectiveness of an increased focus on prevention of illness. The conditions that cause blindness in older people can, if diagnosed and treated early enough, lead to effective prevention in 50% of cases.
The scope for preventing illness extends far beyond the realm of eye health, illustrative though that is. Last month the International Longevity Centre (ILC-UK) published its new report, “Immune Response – Improving access to immunisation for older people” at a Conference, held at the Royal College of Nursing, in London.
The report argues that if we are to ensure our ageing society does not result in greater numbers of dependent older people, we must place an increasing focus on healthy ageing. A healthier older population may be less inclined to withdraw from the labour market, result in fewer days lost to sickness and increase social capital. Older people in good health benefit from improved health outcomes, more active lifestyles and greater autonomy.
The report makes a cogent case for lifelong vaccination programmes. Alongside the existing influenza vaccination programme aimed at older people, there is evidence that vaccination is effective in reducing the incidence of shingles – which affects 250,000 people in the UK each year, particularly among people aged between 50 and 64.
There is a case for extending such vaccinations further, and to a wider age group. Vaccinating health and social care workers would improve the “herd protection” of vaccination among the vulnerable people they deal with. But looking even beyond that, 27.5 million working days are lost due to colds, coughs and flu. Employers and insurers might consider the cost-effectiveness of running their own vaccination programmes.
If we look beyond flu, vaccination can be effective in reducing the incidence of pneumonia and other pneumococcal conditions – currently over 25,000 adults die of pneumonia (mostly people aged over 65). The mortality rate in the UK is the joint highest in the EU and the number of deaths is considerably higher than the number of deaths from flu.
Immunosenescence, the decline of the immune system in age, may strengthen an argument for vaccinating older people before immunosenescence begins, i.e. whilst individuals are in their 50s and 60s rather than later in life, when their immunity is already compromised.
The principle of a lifelong vaccination programme is already accepted in principle in the USA, where the Centers for Disease Control produce guidance aimed at adults, and where lifelong immunization is likely to be a core tenet of “Obamacare” insurance.
Underpinning this approach there needs to be a shared care approach, where people are encouraged to take responsibility for their own health – both by giving them the information they need in easily digestible forms – increasingly apps and other user-friendly formats; and giving them their own portable health and immunization records.
As the population ages, as health systems struggle to cope with the pressures of an ageing society, there is an opportunity here to make a transformative change that will both enhance the health of the ageing population, and improve the cost-effectiveness of health care, and reduce dependence.
Written by David Lye