That’s the message from England’s chief medical officer (CMO) Professor Chris Whitty, who released his annual report last week and called for greater focus on how to maximise independence and minimise time spent in ill health between reaching older age and the end of life.

The fact that people are living longer compared with a century ago is a medical success story, but this does not inevitably mean that older people should have to live for longer periods in ill health.

The report, Professor Whitty’s fourth as CMO, describes how we can maintain older people’s independence through two broad approaches: reduce disease, to prevent, delay or minimise disability and frailty; and change the environment so that people can maintain their independence longer

The geography of older age in England is already skewed away from large urban areas towards more rural, coastal, and other peripheral areas, and will become more so. Efforts to achieve shorter periods in ill health and an easier environment for those with disabilities should concentrate on areas of the country where the need is going to be greatest, says the report.

Older people poorly served by infrastructure

Older people are currently underserved in healthcare, it argues, with less accessible transport links and insufficient infrastructure designed for older adults, including housing. Providing services and environments suitable for older adults in these areas is considered a key priority to enable more older citizens to live independently.

The report calls for research into multi-morbidity, frailty, and social care to be accelerated, and argues that the medical profession needs to focus on maintaining generalist skills as doctors specialise.

Many aspects – such as medical specialisation, specialised NHS provision, National Institute for Health and Care Excellence (NICE) guidelines, and medical research – are optimised to treat single diseases, but the vast majority of older adults often live with multiple conditions at the same time. Increasing specialisation of the medical profession runs counter to optimising treatment older citizens and patients, concludes the report.

“Maximising the quality of health in older adults should be seen as a major national priority,” said Professor Whitty. “We can make very significant progress with relatively straightforward interventions. Older people can and should be better served. We need to recognise and reflect in policy and medical practice where older people are concentrated geographically, increase clinicians’ generalist skills, improve mental health provisions, and make it unacceptable to exclude older adults from research because of older age or common co-morbidities.”

Commenting on the report, Greg Fell, president of the Association of Directors of Public Health, said: “Only by ensuring that people have access to the things that support us to thrive – like good housing, good work and green spaces – can we ensure that people will continue to enjoy good health and wellbeing as they get older. Directors of public health and their teams work in partnership with both local authority colleagues and the voluntary and community sector to help create these spaces, with health and wellbeing at their heart, so that as well as living for longer, people are also living healthier, more fulfilling lives.”

Professor Dame Carol Black, chair of the Centre for Ageing Better, said: “Good health has an enormous influence on people’s enjoyment of later life, but we don’t all have an equal opportunity to age well. Wealth, work, housing, discrimination – all play a significant role in the huge gap in healthy life expectancy between the richest and poorest areas of the country. We also echo the report’s message that we need to aspire to improve the quality of life for people as they age, including through creating homes and communities that help people to age well.”

Generalist skills are key

Professor Dame Linda Partridge, biological secretary and vice-president of the Royal Society, and professorial research fellow at University College London, pointed to the emerging field of geroscience. Capitalising on its promise will “require new treatments and an evolution of approaches across the whole life sciences system, from fundamental discovery to trial design”.

Dr Sarah Clarke, president of the Royal College of Physicians, reflected on the impact of increasing specialisation of the medical profession. “With an increasing number of people with multiple long-term conditions, generalist skills are key,” she said, “as are close working links with primary, community care and the voluntary sector. It’s vital that specialists are supported to feel confident in their generalist skills, to provide joined-up care for these patients.”

Professor Adam Gordon, president of the British Geriatrics Society, echoed these concerns. “There are not enough specialists working in older people’s healthcare and not enough healthcare professionals have developed the right skills to care for this growing population group,” he said.

“The chief medical officer’s call to recognise this as a major national priority is very timely – we’re all ageing and we must act now to grasp this opportunity, ensuring that older people now and in the future are enabled to live healthy, independent lives for as long as possible.”