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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.
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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.  


Example interview Questions

  • 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?
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​Interview Questions & Example Answers


​What is the ageing population?

An ageing population is the term given to a population which has an increasing proportion of elderly people to younger people, resulting in the average age of that population increasing. In the UK there are nearly 12 million people aged 65 and over, with more than 5 million over the age of 75. More than 500,000 people are over the age 90. This led to the average age exceeding 40 for the first time ever in 2014.

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Why do we have an ageing population?

We have an ageing population for two overall reasons. The first is that many people are living longer, due to increases in care for the elderly - and indeed better care throughout people’s lives. From changes such as childhood immunisations, through to better care for those injured in accidents whilst young, to better care for heart disease and stroke in late middle age, to the care of complex geriatric conditions, a huge amount has changed in our ability to keep people alive and healthy for extended periods. Secondly, there has been a decrease in fertility - people are having fewer children and choosing to have their children later in life.


Is the ageing population a good thing or a bad thing?

It should be seen as a positive, if it stems more from a society keeping its citizens alive and healthy for extended periods of time than it does from very low birth rates or fertility issues. We should focus on the many positives - vaccination programs, nationwide campaigns to detect breast cancer and colon cancer early, the management of conditions previously thought of as a life sentence like HIV/AIDS - rather than the issues that may come from an ageing population. However, we should consider the stress that might be put on the healthcare service and plan for it, in order to best allow the elderly in our society enjoyable years of independence, rather than years in which they see themselves - or others perceive them - as a burden.
 

What are the issues of an ageing population?

Our healthcare service is not truly ready to deal with the challenges that an aging population poses. No two old people are alike - one 75-year-old might be entirely healthy, and another on their deathbed - which creates issues when generalising a population. The elderly have comorbidities - as people age, they will present with ever more complex conditions, requiring input from multiple doctors and an increasing number of different drugs.

Different areas of care are currently not well aligned enough to deal with an aging population. As it stands, bed blocking is a huge issue that costs the NHS hundreds of millions per year. This will only worsen as the population’s average increases, unless changes are made.

The elderly also are less likely to be economically active, meaning that the cost of their treatment may not be balanced by their input into the economy, leading to budgetary issues.

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What are the benefits of an ageing population?

There are certain benefits of an ageing population. Firstly, we might focus on the fact that the overall population is likely to be shrinking, or not growing rapidly - which, whilst it may sound strange, is a benefit in a world that is heading toward overpopulation. Therefore, we might expect less crowding and reduced stress in heavily populated areas. We might also see rising wages overall and higher wealth per capita. As the population ages we should expect the elderly to become healthier, and their care to become better - people in their 80s today are as strong as previous generation’s 75-year-olds, for example.


How can we better care for an ageing population?

We must consider how to have a healthy elderly population, who are able to lead independent and fulfilling lives - rather than merely providing reactive treatment to keep people who become ill alive. This means we must focus on public health messaging, encouraging the population to eat healthily, exercise, avoid carcinogens, and otherwise live lives that are likely to lead to better outcomes as they age. We must also consider the care of the elderly in the community - how to rehabilitate them from hospital, and how to provide care to people that choose to remain in their homes rather than live in care homes. We should also consider issues that are particularly relevant to the elderly, like social isolation, and reflect on how to improve these aspects of their lives.

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What area of medicine looks after the elderly specifically?

Geriatrics is the medical specialty that cares for the elderly. It is also known as geriatric medicine. There is no particular age at which a patient would qualify as coming under the care of geriatrics - instead the decision is made based on their individual presentation, and especially after assessing their frailty.


What are the complexities of looking after the elderly in hospital, and of discharging them back home?

The elderly in hospitals will likely have complex conditions with comorbidities. They might therefore require input from multiple different specialties, and perhaps be the subject of MDT meetings in order to best plan their treatment. They may require particular monitoring. They may also be acutely confused, or have ongoing dementia, that makes their care more difficult, especially for the nursing staff. When discharging the elderly home, one must consider whether they have been rehabilitated to such an extent that they are safe to return and consider where they are going. Their home might need to be altered, or carers be brought in - or they might need to be discharged to a care home. Whilst bed blocking is a problem, no elderly person should be discharged if this is unsafe.