Take a stand against ageism

NHS England’s National Clinical Director for Older People and Person Centred Integrated Care, Professor Martin J Vernon, blogs on why we all need to take a stand against ageism and celebrate the contributions older people make to society.

On reaching the age of 72 and reflecting on the subsequent changes in attitude towards her, the musician and artist Yoko Ono commented: “I started with racism and sexism in the beginning and fought them so hard and was finally ready to relax. Then, here comes ageism, and I feel like, give me a break!”

We are more likely today than ever before to live into old age. So now is a good time to think about what that means for us, our families, and older people with whom we all share our lives. The recent International Day of Older Persons (1 October) provided us all with opportunity to celebrate the contributions older people make, and have made during their lives to our society. It also gives us time to think about the issues and challenges of ageing in today’s world.

In 2016 we are being urged to Take a Stand Against Ageism.  What are the impacts of discriminating against, and harbouring negative attitudes towards a person based purely on their age?  I will not be alone in believing that a good measure of a just society is the value we see in all people, their lived experiences and their positive contributions irrespective of their circumstances. Ageing is inevitable and continuous for us all: maintaining health and well being throughout life for all of us must be everyone’s business.

Fortunately there are quite a number of straightforward things we can do to help achieve this. NHS England in partnership with older people, Age UK, Public Health England and the Chief Fire officer’s Association has published a Practical Guide to Healthy Ageing. While aimed at everyone, it is particularly relevant for people aged 70 or older and especially those who are beginning to find themselves slowing down and taking longer to do the basics of life.

A few days ago I saw a man called Geoff (not his real name) on a surgical ward. He had been admitted to hospital a few days before with serious chest injuries having tripped over at home whilst on his way to the bathroom. Despite his 82 years and being visually impaired, having chronic lung disease and a heart condition, Geoff had remained fully independent and was enjoying life right up until he fell over.

With excellent surgical care he was making a speedy recovery and with a few adjustments to medications, a programme of balance exercises and a walking frame, his physiotherapist and I were confident that Geoff would soon be able to get safely back home.

After further discussion Geoff agreed that he would be able to get home with a package of support while he restored his confidence. I was struck by his determination not to let this difficult and traumatic life event beat him: as I left him he grinned ‘we are made of tough stuff in Bury’.

Geoff’s final comment is testament to his emotional and physical resilience and in keeping with his many colourful life achievements.  I thought about him when looking at the Public Health England Older People’s Health and Wellbeing on line atlas. For a man in Bury, average life expectancy at age 65 is just under 83 years. Geoff looks set to far exceed this and quite probably the average for England of almost 84 years. The variation demonstrated by the atlas is however striking: a 65 year old living in Kensington and Chelsea could expect to achieve nearly 87 years on average while if he lived in Manchester city average life expectancy would be only 81.

Ageing well is a key component to smoothing out this variation across the country. This is why it is so important for us to systematically find and support those older people who are losing resilience more quickly than their peers. Frailty is the accumulation of physiological deficits, which places people at greater risk of poor outcomes following an acute stressor event. It can creep up on us slowly and cause havoc when accidents or minor illness intervene.

Geoff has looked after himself and as a result has withstood a traumatic life event with remarkable fortitude: I agree with his own assessment that he has managed to look after himself despite his multiple ailments. Routine identification of people with early frailty who are not as robust as Geoff coupled with a structured assessment gives us an opportunity to better equip them for whatever lies ahead in life. Doing this at scale means we can better target simple and evidence based interventions to maintain robustness  such as keeping active, eating and drinking well and much more as set out in the Guide.

Proactively finding those most at risk is only the start of delivering better outcomes for older people. For Geoff, high quality trauma care, falls risk reduction and preservation of his autonomy and control over his life are key outcomes. But for others there are equally important outcomes we should be working towards delivering.

International Day of Older Persons provided a great opportunity to consider how international collaboration can assist us in addressing unwarranted variation in outcomes for older people. The International Consortium for Health Outcomes Measurement (ICHOM) provides one such example.  Working in collaboration with NHS England ICHOM have recently published a standard older people outcomes set founded on the principle that outcome based treatment decisions can deliver value based health care. This is well worth considering when deciding with an older person, and those important to them, how best to deliver their care.

As the French author Jules Renard sagely observed: ‘It’s not how old you are, it’s how you are old’.

Martin Vernon

Professor Martin Vernon was appointed National Clinical Director for Older People and Person Centred Integrated Care at NHS England in 2016.

He qualified in 1988 in Manchester and following training in the North West he moved to East London to train in Geriatric Medicine where he also acquired an MA in Medical Ethics and Law from King’s College. He returned to Manchester in 1999 to take up post as Consultant Geriatrician building community geriatrics services in South Manchester.

Martin was Associate Medical Director for NHS Manchester in 2010 and more recently Clinical Champion for frail older people and integrated care In Greater Manchester. He has been the British Geriatrics Society Champion for End of Life Care for five years and was a standing member of the NICE Indicators Committee.

In 2015 Martin moved to Central Manchester where he is Consultant Geriatrician and Associate Head of Division for Medicine and Community Services. He also holds Honorary Academic Posts at Manchester and Salford Universities and was appointed as Visiting Professor at the University of Chester in 2016.

In 2017 he became Chair of the NHS England Hospital to Home Programme Board and is working on National Frailty Care with NHS Improvement.