The number of people over the age of 65, and additionally the number of people over the age of 85, is increasing in all developed countries; the population is ageing. This has led to concerns over the use of health care resources, as people over 65 are major consumers of health care. It has also led to more resources being devoted to research into issues which are primarily associated with older age.
The prevalence of many medical conditions is higher in older than in younger people, including chronic pain, stroke, many respiratory and cardiac conditions, dementia, depression, osteoarthritis, and type II diabetes. The prevalence of multiple health conditions within the same person is also higher in older than younger people, and associated with this is increased use of multiple medications, which can bring additional problems such as drug interactions. Therefore effective, non-drug interventions, such as tailored exercise or physiotherapy-based rehabilitation programmes, are highly appropriate for this group.
Not all older people are frail, but frailty does become more common in older age groups. Frailty has several alternative but closely linked definitions. One definition relates to the accumulation of multiple health conditions (as mentioned above), another focuses on the reduction of physiological reserves such as lung capacity and muscle strength, so that normal activities use a higher proportion of a person's maximum capacity. There is some evidence that the same medical conditions are more disabling in older than younger people, possibly because of these reduced reserves.
Falls and falls-related injuries are commoner in older than younger people. Many factors which make falls more likely are more prevalent in older than younger people, such as reduced muscle strength and poor balance. Annually in the UK, one person in three over the age of 65 will have at least one fall. Reduction in bone density with increasing age makes fractures more likely. These factors are all amenable to non-drug interventions.
Research being undertaken by the Centre for Rehabilitation Research in Oxford includes projects using non-drug interventions for conditions which are common in older people, such as falls, low back pain and dementia. Priorities include reduction of problematic symptoms, maintenance of independence, maximisation of quality of life and minimisation of burden on carers.
Projects of particular relevance to our ageing theme are shown below.