England’s chief medical officer, Prof Chris Whitty, has called for a cultural shift in medicine away from maximising lifespan and towards improving quality of life in old age, arguing that sometimes this means “less medicine, not more”.
Speaking before the publication of his 2023 annual report, which this year focuses on health in an ageing society, Whitty said doctors needed to have more realistic conversations with patients about the risk of some treatments extending life at the expense of quality of life and independence.
“Modern medicine is amazing at keeping people alive and extending life … and this for some people is exactly the right thing to do,” he said. “But I think the question should be what do people want themselves, and, particularly if treatments have significant side-effects, you’re always going to have a trade-off.”
He also urged families not to shy away from conversations with older relatives about health choices such as the extent to which they would want medical interventions to be escalated in an emergency. These discussions could be mediated by a GP, Whitty suggested, and need not be “frightening conversations”. “If you talk to older people, they will all want to have this conversation,” he said.
The wide-ranging report highlights the demographic timebomb faced by rural and coastal communities, whose populations are projected to age far more rapidly than those in urban areas. These areas also tend to be underserved by healthcare and lack housing and transport infrastructure designed to allow older people to live independent, active, healthy lives for longer.
On the Isle of Wight, for instance, almost a third of residents are over 65, and in North Norfolk nearly a quarter, and both areas are projected to see rapid ageing of the population in the next 20 years.
“The biggest concern I have is that government and professional bodies have not recognised the degree to which the population living in older age is concentrating geographically,” Whitty said in his report. “Being an older person in many parts of the country is extremely difficult. Houses are built for young families, yet we’ll soon be in a situation where a fifth of the population are over 65, and if you look to the middle of the century, a quarter.”
Whitty said the expansion of medical schools and training opportunities should happen in areas with rapidly ageing populations, such as Cumbria and the south coast, to attract more doctors and nurses to these regions.
Whitty said individuals could take important steps to extend their healthy lifespan, including stopping smoking, moderating alcohol consumption, having a balanced diet and exercising. “They’re old-fashioned but they still work,” he said. Of these, he said, people most often underestimated the “extraordinary effects” of exercise on multiple aspects of health, including delaying dementia and heart disease, reducing the risk of falls and boosting mental health.
The report criticises the systematic exclusion of older adults from clinical trials and medical research, which Whitty said was often not scientifically justified. He said there should be a move away from using arbitrary age cutoffs for participation in trials and from excluding people with multiple morbidities, which he said risked skewing results. However, he stopped short of saying that inclusion of older people in trials should be mandated for publicly funded research.
The report also highlights health inequalities, with people in more deprived areas less likely to experience good health. Women in the most deprived 10% of areas of England have a shorter life expectancy and spend about a third of their life in poorer health compared with women in the most affluent areas, who spend a fifth of their life living in poorer health.
Paul Farmer, the chief executive of Age UK, welcomed the report and said: “It clearly demonstrates why we need politicians and policymakers across the board to get a grip and make the task of adapting to the realities of our ageing population a priority. This is why at Age UK we are calling for a cross-government ageing strategy and minister for older people urgently. There are both challenges and opportunities in increasing longevity, but taking the steps required to prepare and adapt is essential if we are to avoid the pitfalls and realise the potential.”
