It’s not how old you are that matters, so much as how you are old…

Professor Martin Vernon qualified in 1988 in Manchester. Following training in the North West he moved to East London to train in Geriatric Medicine where he also acquired an MA in Medical Ethics and Law from King’s College. He has been the British Geriatrics Society Champion for End of Life Care for 5 years and was a standing member of the NICE Indicators Committee. In 2016 Martin was appointed National Clinical Director for Older People and Person Centred Integrated Care at NHS England.

mj-vernon-officialWhile celebrating successful ageing we must not be led into complacency. There is marked inequality between least and most socioeconomically deprived areas with men living on average up to 8 years less in the most deprived areas.

The NHS England Five Year Forward View notes that support for frail older patients is one of the three areas that the NHS faces particular challenges. It is therefore potentially game-changing that we are now making positive steps towards addressing this through routine frailty identification and promoting key interventions targeted at falls risk identification and medication review.

In February 2017 NHS England announced changes to the core GP contract which will for the first time in England give us the ability to systematically identify frailty nationally.  Using an appropriate tool (in the main this will be electronic frailty index -eFI) practices will identify patients aged 65 and over living with moderate and severe frailty. For those patients identified as living with severe frailty, the practice will deliver a medication review and where appropriate discuss whether the patient has fallen in the last 12 months. Information relating to this activity will be coded into the electronic health record and where possible reported in the summary care record.

NHS England will also collect data on the number of patients recorded with a diagnosis of moderate or severe frailty, and the number of patients with severe frailty who are recorded as having had a fall in the preceding 12. This information will for the first time help us to understand the prevalence of frailty by degree among practice populations and nationally.

Making the shift from opportunistic identification of frailty to systematic population based identification of frailty, will help to reduce inequalities and improve access to care. As we continuously optimise public services we must have due regard both to the needs of older people who remain fit, and systematic identification of those with declining resilience. This provides a triple aim of keeping fit older people healthy and active, delaying the onset of poor quality ageing and meeting the needs of those who are not ageing well through to the end of their life.

In setting the pace of change we must also not lose sight of the fact that the UK population is ageing fast: recently the average population age exceeded 40 for the first time.  In the next twenty years one in seven of us will be aged over 75 and we will be living in a different society where more people are in older age groups than ever before. This has implications for how we approach both our own old age and that of our family members. While pursuing  equitable and sustainable high quality health and social care for the entire population, system leaders must now take care to ensure that policy and planning reflect the scale and impact of population ageing on employment, housing, transport and family life.

We have much to do. The 2016 Foresight report encourages us to develop whole life course policies, taking into account the growing interdependencies between generations. Lone parent families have grown by over 10% to 3 million in the last decade and in the next 20 years there will be 1.4 million more households headed by someone aged 85 or over.

Responding positively to the challenges of an ageing population requires us to take a clear and consistent approach to defining the scale and scope of the needs of the population at various stages in the advancing later life course. Understanding frailty as a progressive long-term condition is crucially important to achieving this.

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