Healthy ageing: ageing safely.

The population of the developed world is steadily ageing. In the European Union, approximately 22% of persons are over 60 years of age and this is projected to increase to more than 27% by the year 2020. This has major implications for health care resources and the productive workforce. Ageing is accompanied by a decline in the physiological reserve of all organ systems, compromising homeostasis and resistance to disease. Thus, when disease develops in the elderly it has an increased impact on organ systems not directly involved. This places older people at risk for multiple simultaneous pathologies. Treatment often requires polypharmacy, which often is accompanied by drug interactions and adverse reactions. The pattern of sequential and comorbid disease often means that the later years of life are associated with an accumulating toll of disability, which in turn consumes a high proportion of health-care resources. The major goal of health care in the elderly should be to compress morbidity into the end of the normal lifespan. To achieve this, it will be necessary to redefine our approaches to treatment in the elderly and to develop an evidence base to inform this process.