BMJ  2007;334:651 (31 March), doi:10.1136/bmj.39164.428044.1F

Letters

Caring for oldest old

Oldest old are not just passive recipients of care

Although Robine et al raise serious points about future trends in ageing, dependency, and care provision in later life,¹ it is also worth noting that older people are also creative in their stratagems for later life and are not just passive recipients of care. Of particular importance is the contribution that they themselves bring to their own care. A longitudinal study of ageing in Ireland found a marked increase in the amount that older people spend on provision of health and social care² over a four year sampling period, despite increases in access to services such as free general practitioner care. Over 8% of older people in this study were themselves the primary carer for another family member.

Therefore, even in advanced old age, a sense of partnership between services and all older people needs to be developed. Enabling this partnership, and responding to the changing demands of health and social care services, will require increased emphasis on effective care for older people, whether through acute geriatric medicine (which can reduce death and disability by 25%)³ or by improved chronic disease management.⁴ It will also require some thought to ensuring that the societal structures, such as housing and transport,⁵ do not hinder participation of the oldest old in sharing in their own care.

¹ Department of Medical Gerontology, Adelaide and Meath Hospital, Dublin 24, Republic of Ireland, ² Department of Health Services Research, Royal College of Surgeons in Ireland, Dublin 2

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Competing interests: None declared.

References

1. Robine JM, Michel JP, Herrmann FR. Who will care for the oldest people in our ageing society? BMJ 2007;334:570-1. (17 March.)[CrossRef][Medline]
2. O'Hanlon A, McGee A, Barker M, Garavan R, Hickey A, Conroy R, et al. Health and social services for older people II (HeSSOP II): changing profiles from 2000 to 2004. Dublin: National Council on Ageing and Older People, 2005.
3. Ellis G, Langhorne P. Comprehensive geriatric assessment for older hospital patients. Br Med Bull 2005;71:45-59.[Abstract/Free Full Text]
4. Lorig KR, Ritter PL, Laurent DD, Plant K. Internet-based chronic disease self-management: a randomized trial. Med Care 2006;44:964-71.[CrossRef][ISI][Medline]
5. O'Neill D, Dobbs B. Age-related disease, mobility and driving. In: Transportation in an aging society, a decade of experience. Washington, DC: Transportation Research Board, 2004:56-68.

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