November 10, 2023

expert reaction to Chief Medical Officer’s Annual Report 2023 on Health in an Ageing Society

Scientists react to the Chief Medical Officer’s Annual Report. 

Dr Wendy Martin, Senior Lecturer, Department of Health Sciences at Brunel University London, said:

“The Chief Medical Officer’s report Health in an Ageing Society is an important and timely report on the health and wellbeing of older people. The report highlights the diversity of older people and how social inequalities in health across the life-course continue through our old age.

“Whilst growing older can be a time of possibilities and opportunities for some older people, it can be a time of poverty and hardship for others. The spaces and places in which people age are also brought to the forefront of the report in which the homes and communities in which people live are central to their health and wellbeing.  It is therefore the quality of life that needs to be focused on rather than only an emphasis on living longer and to understand more about the societal and environmental context in which we all age.

“The report also highlights how under-researched the health and wellbeing and the lived experiences of older people are. Ageing is a key theme within Brunel University London, and the complex nature of the health and well-being of older people in the report shows the importance of our interdisciplinary approach to research. Moreover, the perspectives of older people are central to our research as we work collaboratively with members of the Brunel Older People Group (BORG) as we design and conduct our research.”

Dr Mariam Molokhia, Clinical Reader in Epidemiology & Primary Care at King’s College London, said: 

“This landmark CMO report on healthy ageing highlights priority areas, requiring an agile response to the dynamic and complex needs of our older population for physical and mental health optimisation. 

“Leveraging both preventative and environmental approaches offer tangible ways to transform future good health with positive impact, but challenges in inequities of delivery and uptake remain. 

“It is essential to have high quality data, use data science in innovative ways, and adopt a multi-sectoral approach to understand areas of greatest need. We need to help our aging population on their journey to good health by addressing medical, environmental and social determinants of health and providing effective tailored and community-based interventions, supported by policy.”

Professor Claire Steves, Professor of Ageing and Health and Director of King’s College London new Centre for Ageing Resilience in a Changing Environment, said:

“This report is very much welcomed as it highlights the challenge with an ageing population and the gains we could make if we work now to optimise resilience in older adults.  This challenge is made doubling important by the stressors in our system – a changing economy, weakened health care service after COVID-19 and impending climate change which is already disproportionately affecting older adults.

The focus on geography and its intersection with ageing is also welcomed, and local factors are really important in ensuring resilience of older people – from providing insulation in housing, safe accessible places to engage in physical activity, to delivering health care services designed with older people’s needs in mind. However, we must not forget that percentages of the population may be misleading.  There are still large numbers of older adults living in urban areas, often in deprived settings, but as these areas have high populations of young people the percentage that are 75s is lower than in rural, less populated areas.

Every borough and region in the country, therefore needs to think about how it is building the resilience of our older populations.”

Professor Lynne Cox, University of Oxford, Co-Director, UK Ageing Research Networks, said:

“The CMO’s report presents an excellent and wide-ranging view of ageing health in the UK. It makes sensible actionable recommendations including redistribution of resources to geographic areas with a high portion of older adults with significant health care needs. The report shows that government has a major role to play in reducing socioeconomic inequalities to close the healthspan gap, and in enabling older adults to continue to live independently by improving infrastructure and the built environment, but this emphasis would have been better if balanced with a clearer statement on progress in developing new drugs/therapies for older adults at risk of, or already suffering from, age-related diseases.

“The emphasis on generalism in clinical training is welcome in the context of multimorbidity in ageing, but it would have been useful had the report also made a stronger case for increased number and career options for clinical geriatricians who work in a highly complex specialty. It is also very encouraging to see a strong steer to companies and regulators to include older adults in clinical trials for therapies relevant to their medical conditions. Acknowledging that we need to understand how environment and lifestyle impact on ageing biology is also positive.

“While the executive summary is clear in emphasising that ill health is not inevitable with ageing, sections of the full report repeat the unhelpful trope that multimorbidity is an expected consequence of ageing– despite the clear examples of new therapies in phase 3 clinical trials for complex ageing conditions such as neurodegeneration and age-related macular degeneration cited in chapter 7. A similar passive acceptance is apparent in the chapter considering infections in older people – vaccination and standard infection prevention measures (as well as the emerging threat of antimicrobial resistance) are covered well, but there is no mention of new treatments designed to improve immune function in older adults.

“The excellent chapter at the end of the full report highlights the strengths of the UK in basic ageing science and the small but growing biotech industry building up around that; it also calls for joined-up thinking to bring that expertise together with national resources such as UK Biobank and the NHS to streamline drug discovery and clinical trials. The rapid progress enabled by geroscience in developing broad-range therapeutics to treat or even prevent multiple diseases of ageing is also well described. It is therefore unfortunate that these exciting advances are missing from the executive summary.

“Throughout the report, there are strong statements about the need to delay onset of age-related diseases to compress the period spent in ill health at the end of life. This is important and cannot be overstated – but a major omission is a robust and thorough health economics work-up of the current and projected costs of ill health associated with ageing compared with the benefits of new therapies that effectively treat/prevent age-related diseases, developed through geroscience studies.

“It is a shame that the report has missed an important opportunity to demonstrate the cost-effectiveness of increasing funding of biomedical ageing research leading to new therapeutics, and to show the financial rewards of stimulating the UK biotech industry. Such a demonstration would have been powerful in persuading the Treasury and the rest of Government of the value of geroscience research to the UK.”

Ilaria Bellantuono MD PhD, Professor in Musculoskeletal Ageing, Co-Director of The Healthy Lifespan Institute, University of Sheffield, said:

“I welcome the Chief Medical officer’s recent report. There is much to like about this report, including the focus on preventing or delaying multimorbidity and frailty and the need to identify solutions that maximise the independence of these patients and minimise the time in ill health. It is encouraging to see a strong statement on the need to include these patients in clinical trials. Also encouraging is the acknowledgement that increased specialism in the training of healthcare professionals is not optimal for the care of these patients and more needs to be done to train healthcare professionals to maintain generalist skills. I particularly welcome the supportive statement to increase research in understanding clusters of multimorbidity to improve preventive strategies and services. Overall, this is a report that, if enacted, will make a real difference.”

Professor David Oliver, Consultant Geriatrician and former President of the British Geriatrics Society and Ex Department of Health National Clinical Director for Older People, said:

“I am delighted to see the Chief Medical Officer focussing so strongly on the implications of population ageing for society, for the health service and for older people and their families.

“Population ageing represents a triumph not only for healthcare and preventative public health but for wider socioeconomic conditions and public policy, although the rise in both absolute and healthy life expectancy are now stalling and health inequalities and incidence of potentially preventable long-term conditions growing. It also gives all of us a better chance to live and thrive for longer than would have been imaginable when the NHS was founded, and life expectancy was in the 60s. 

“However, it does come with challenges. As the CMO rightly points out, a major part of the business of modern health care does not focus on single or curable conditions but on people living with multiple long-term conditions, often compounded by frailty, or dementia or age-related disability. And although we aim to keep people well for longer, there will be a period towards the end of life where most people do live with these problems. They may be life limiting, create a burden for the millions of unpaid carers – often older people themselves and lead to high use of health and social care services whether primary, secondary or community care.

“Prof Whitty’s call to invest more in and grow the number of expert generalists such as geriatricians and skilled multidisciplinary teams who can support older people with these complex biopsychosocial needs is welcome as is his call to invest more in research on people living with multiple conditions and in systems of care and not just the current focus on single treatments for single organ conditions.

“I am also grateful to see his focus on prevention – both primary and secondary, to enable people to remain in better health across the life course and including in later life. This is not just about healthcare but the wider socioeconomic determinants of ill health and tackling major risk factors.

“Finally, whilst this is not a major feature of his report, I think it is crucial that we find a sustainable long-term solution to social care funding and provision and support for unpaid carers and develop far more co-ordinated and less disjointed systems for people likely to use multiple services and see multiple professionals. And we need a better focus on care planning, co-ordination, and support in the last year or two of life to enable people to have better deaths and fewer of them to die in acute hospitals.

“With older people being the most frequent users of health and social care services, getting care right for them can help get care right for all.”

Paul Farmer, Chief Executive at Age UK said:

“We welcome this powerful and timely report from the Chief Medical officer. It clearly demonstrates why we need politicians and policy makers 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.

“A society that doesn’t function for a large, and rapidly growing, part of its population can never be truly successful. We can already see how the failure to invest in delivering the right services and support is leading to worse outcomes for older people and entirely avoidable problems. Older people are isolated at home if the design of our communities mean they can’t safely go out. People end up falling and in the back of an ambulance if our built environment is full of trip hazards. Our hospitals are over capacity at least in part, due to the failure to provide adequate social care and community services to enable people to stay safe and well at home. None of this is inevitable. Getting it right would have immeasurable benefits for individual older people and their families as well as our communities and society as whole.”

Fiona Carragher, Alzheimer’s Society’s Director of Research and Influencing, said:

“We welcome the light that this report shines on the challenge of an ageing society and its recognition of the value of early dementia diagnosis. The Chief Medical Officer’s recommendations around involving more older people in research, and for better health data, will be key to tackling dementia. 

“Our ageing population means the scale of the challenge is undeniable – dementia is the biggest health and social care issue of our time. 900,000 people in the UK are living with this devastating, terminal condition and too many are facing it alone without the vital support they need.  

“As the report acknowledges, older people are currently underserved in health care. One in three people born in the UK today will develop dementia in their lifetime. That is why Alzheimer’s Society is urging the Government to make dementia a priority. We urgently need to increase diagnosis rates and transform social care by investing in the workforce and a sustainable funding model.” 

Professor Mike Tipton, Chair of The Physiological Society’s Policy Committee, said:

“Physiology is central to understanding how our bodies work as we age across the life course. Physiology is also critical understanding the healthy ageing process, the causes and consequences of age-related diseases, and the lifestyle and medical interventions that will allow people to live healthier for longer.

“This means more people being able to enjoy extra years with their family and contributing to society, as well as easing the burden on health and care systems.

“However, as CMO’s report identifies, older adults are often systematically excluded from research. The consequence is that we do not have a complete picture of why physiological function declines with age, what aspects of ageing are inevitable and how to best support the application of physiological research to ensure that the public benefits from relevant research.

“This is a vital area of physiological research, and I am delighted the CMO has shone a spotlight on the opportunities it presents.”

Linda Partridge, Professorial fellow, Division of Biosciences, UCL, said:

“The increasing presence of people over 75 in the English population, and their concentration in coastal and rural areas, are interesting challenges for the coming decades. Chris Whitty and his colleagues are to be congratulated on collating a huge amount of information to provide a valuable basis for action to promote the health and quality of life of older people. The aim is to compress the period of late-life functional decline and illness, particularly under conditions of social and economic disadvantage. Unnecessary barriers to progress are highlighted, notably repeated failures to include older people in clinical trials. Recent research in geroscience gives increasing promise of prevention, by targeting the biological mechanisms of ageing, an area of research and innovation in which the UK is well positioned to contribute. We now have a clear roadmap to follow.”

‘Chief Medical Officer’s Annual Report 2023 on Health in an Ageing Society’ was published at 00:01 UK time on Friday 10^th November. 

Declared interests

For all experts, no reply to our request for COIs was received.