When a 70 year old woman collects a prescription from the pharmacist, no one is surprised. But, it is for her mother. And she must rush back because her mother doesn't see very well, is a little confused, and her daughter doesn't like to leave her for too long on her own. Times change. We are all getting older and living longer so our traditional age structured model of society has had to evolve. No longer are people young, middle aged, and old, but increasingly they are also the “oldest old.” In this week's BMJ, Robine and colleagues present a “four age population model,” whereby the future long term care needs of the oldest people can be estimated.”1 These frail elderly people, whom we are likely to become, are increasingly important as consumers of health resources and a focus for future care.

The irony of longer life is an increasing burden of health. We …