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Medicine Interview Hot Topics: The Ageing Population

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​Overview

​The ageing population will have an effect on the NHS - both in terms of the general population and the NHS’s workforce. You should have an idea of the amount of the UK population who are over the age of 65 - around 18%. An ageing population is simply one where the median age of the overall population is increasing, as life expectancy rises (and as births may be slowing).  


How to approach treating an ageing population

As the population ages, we must learn to care for the elderly better. Firstly, that involves focusing on frailty as the primary driver of care rather than chronological age. No two 75 year olds alike - one may still be running marathons and the other bedbound. Through using frailty rather than age, we can better provide care to those that need it. We must act to reduce incidence of falls, which can have a huge impact on the elderly, be aware of the physiology of ageing, and be aware of the difficulties of providing treatment for the elderly when they are billed as ‘geriatric medicine’ patients, yet require complex treatment from many specialties, necessitating MDTs.

We should be quick to acknowledge the importance of treating comorbidities as people age, and of all doctors retaining knowledge of common cardiovascular conditions.

All areas of care must work together to provide high quality care for the elderly. This means integrating primary and secondary care, improving care in the community, improving the cycle of assessment → admission → discharge. Without this improvement, bed blocking (when a patient isn’t able to be discharged for an extended period due to an inability for them to safely return home) can cost the NHS hundreds of millions of pounds per year. This is reliant on allied healthcare professionals like occupational therapists, and on MDTs.
We should emphasise public health messaging to ensure that the elderly enter their later years with as good a basis for health as possible. With fewer comorbidities caused by smoking, drinking, lack of exercise and the like, we can have a far healthier older generation. That should be the aim - not to extend life but to extend quality of life. 


Ageing population affects physicians too

Of course, we all age. As it stands, limits on lifetime taxable allowance for pensions and a challenging working environment is forcing many experienced doctors to retire early. The NHS should be aware that, as we stay healthy longer, many of its physicians who hold the greatest levels of expertise could work on far beyond the age at which they might choose to retire if they feel uncared for by the service. Through providing them with the opportunity to remain in an environment that welcomes them, or to work part time or in teaching roles, we can ensure that we do not lose expertise before we must.  


Is an ageing population an issue?

No. an ageing population is a sign that a society’s ability to keep its citizens healthy has benefited them, and that they are now able to live longer lives. That is clearly a positive. Famous public health campaigns to detect cancer far earlier than ever before - be it breast cancer, colon cancer, or testicular cancer - are just one example of the way in which public health work results in an increased life expectancy. Think too about vaccinations - be it reducing child mortality through measles, mumps or rubella - or the flu vaccine reducing mortality in the elderly. Many chronic conditions can be managed in a way that was thought impossible as recently as the 90s, like HIV/AIDS. However, many would argue that the quality of life for many of the oldest members of our society - who may have severe dementia alongside a host of other problems - simply is not good enough, and that Western medicine has a tendency to seek to extend life spans unnaturally, and unnecessarily.  


Potential questions which may be asked in your interview

What is the ageing population?
Why do we have an ageing population?
Is the ageing population a good thing or a bad thing?
What are the issues of an ageing population?
What are the benefits of an ageing population?
How can we better care for an ageing population?
What area of medicine looks after the elderly specifically?
What are the complexities of looking after the elderly in hospital, and of discharging them back home?