[Population Health] Our ageing society

The population of the world is higher than ever before, and continues to rise. The population of the UK in 2017 was estimated at over 66 million. This is increasing demand on healthcare services, but the services themselves are continuously expanding. There are more patients than ever before, and there are more healthcare workers than ever before. Unfortunately, humanity's resources are lower than ever. This unregulated growth and unsustainable consumption is probably the biggest threat to our world. But the problem for healthcare is more complex than this.

Living longer

The average life expectancy of the UK in 2018 is estimated at 79.2 years for a man and 82.9 years for a woman. With improving technology and protocols, millions of people who would have died of cardiovascular disease, infections, cancers, or trauma, are surviving. Sadly, it's easier to survive than to live well. Most people are now surviving long enough to see every piece of their bodies fail. The older people get, the more likely they are to have several morbities (diseases). These days, multi-morbid patients can live for decades, we can make their quality of life better, but we can't fix everything.

There are several major hurdles that we have not been able to resolve:

Musculoskeletal function

Kidney function 

Intestinal function

Liver function

Brain function 

Heart function

 

The impact on society

So what does this mean for healthcare professionals and society in general?

Firstly, elderly multi-morbid patients need constant monitoring for their problems and care from many types of different professionals. In their final years many of these patients spend most of their free time in healthcare. Some patients, especially those with dementia, need constant monitoring and help with activities of daily living. This population is constantly expanding and living longer than ever before, so the demand for people in these roles is going to grow continously.

Secondly, you'd probably be shocked to see how many medications the geriatric population are on. In healthcare, this is known as polypharmacy (many-drugs) and it's a huge burden on patients. Common drugs include anti-depressants, gastroprotectives (protection against stomach acid), analgesics (pain-killers), anti-hypertensives (blood pressure reducing drugs), laxatives, anti-diabetic medications, diuretics (fluid lowering drugs). Taking the prescribed medications correctly is a challenge, even for patients with healthy cognition, and particularly if they have an impairment.

On top of this, the range of medications patients can take is limited by their organ function. A patient with severe renal and hepatic impairment might not be able to achieve optimal drug therapy because their body cannot process the drugs at the doses they need. Many patients are denied surgeries which could enormously improve their quality of life because it is believed that they won't survive the operation.

The future

I have strong hopes that advances in prosthetics and tissue engineering will allow our patients to get a "fresh start". We could theoretically replace joints, organs and complex body parts like limbs. This will reduce polypharmacy, reduce the time that patients spend in healthcare, and give them a higher quality of life until the end. Patients will no longer have to live with pain, indignity and immobility for years. An organ full of tumours could be simply replaced. Advances in immunology and genetics might allow us to minimise causes of dementia like Alzheimer's disease. It's less obvious how we can reverse declining cognitive function. Perhaps neuronal regeneration will be a possibility and perhaps electronics will play a role in preserving our cognition and our consciousness.

It seems most likely that advances in technology will mean that the vast majority of people die by dementia, or suicide. This is going to be a massive strain on society. Even now it's already clear that we must change how we care for patients with dementia. Workers in care homes are usually highly stressed. Elderly people without sufficient financial savings often end their days in ill equipped facilities where nobody would feel happy. Few people want to work in these settings so they're often understaffed.

Advances in artificial intelligence (AI) are likely to make a lot of workers redundant and future generations are likely to have completely different career options. One thing that is not likely to change: people will want to have contact with real humans. I think that the workers of tomorrow might earn a living by helping the elderly to end their lives with minimal suffering. And although I don't consider it a substitute for human care, artificial intelligence could help to reduce the burden of caring for dementia patients. For example, monitoring of at-risk patients could be done by AI surveillance. AI programmes could prompt the forgetful to do what they were supposed to do. This could allow people to live independently for many more years.