Manageing an Ageing Population or NOT!

My Hospital Guide 2013: Essential Reading for Smart Spending
Remember the millenium bug - millions of pounds were spent in preparation for a post apocalyptic world. In the end the central heating timer just needed re-setting.
The reason I bring the subject of the Millennium bug up is something else that we are constantly reminded of  -  the ageing population and how we must be prepared for the consequences. In case nobody has noticed, the population has always been ageing - well part from those years when the Black death had a say in demography! We are however reaching a point, a tipping point, when the length of the bars reflecting the over 75s is becoming significant. In the old days, you were fit and skipping along merrily until one day, a sniff of plague infested air and bang, 2 weeks later you are no more. Today citizens occupying those bars in the upper echelons of the Demogram don't quite shuffle off this mortal coil in such a rapid fashion. Look at poor Nelson Rolihlahla Mandela - he spent the final months of his life in and out of hospital, ditto Dom Mintoff, ex iconic 1970s Socialist Prime Minister of Malta who died last year aged 96. Likewise he spent the terminal 2 years of his life bouncing in and out of hospital - is he or is he not.. everyone wondered with bated breath.
That's how old people die - slowly, of respiratory or urinary infections, infections that in a man or woman half their age would be trivial but in post octagenarians prove fatal. If this is the shape of things to come, and they (the mysterious proverbial omnipresent 'they') say it is, surely these frequently pre-terminal or terminal events should be managed outside hospital.
This excellent report from Dr. Foster Intelligence (highlighted above) informs us that we are failing to manage the inevitable. The admission rate to hospital for urinary tract infections in patients over 75 has increased by a mind boggling143% in 10 years. We really are at that tipping point and something needs to be done NOW, well soon anyway! 

The 'Surgicalisation' of Old Age.

This is a republishing of a post I originally wrote in December 2010. It's a point that needs to be re-emphasised every so often!

Surgeons’ Decisions and the Financial and Human Costs of Medical Care

A good piece by an anaesthesiologist in the NEJM. What I found interesting was the fact that there used to be a chapter on surgical judgement instructing surgeons when not to operate in the 1960 edition of a major surgical textbook. The chapter had disappeared by 1972. As surgical and anaesthetic techniques improved, the scope for surgical intervention was extended to sicker and older patients. Now the emphasis on cost containment in a world that is broke and on patient reported outcomes,  is beginning to apply the brakes on that hubristic approach. It is however that kind of approach that frequently plays an important part in the advancement of medicine. With much greater scrutiny on doctors' performance, that kind of approach has now become increasingly socially and some might say morally unacceptable.

Frailty and Cardiovascular Disease.

Another paper looking at interaction of old age and frailty, and outcomes in cardiovascular disease. We need more of these papers. Demographics suggest that the number of people reaching their 80s or higher will increase exponentially. Dementia has quite rightly grabbed all the headlines as a consequence of this demographic change. Cardiovascular disease including aortic valve stenosis and its often invasive treatments must also be considered when we study old age and its effects.