Changing health needs of the ageing population.

The drama unfolding in this century can be viewed in terms of the age at which people are now dying. Most medical needs, attention and costs occur in the last years of life. At the turn of the century about 25% of people survived age 65. In the developed countries at least 70% of the population now survive beyond this age and 30-40% of deaths are at age 80 or over. Entirely different diseases, conditions and social structures are involved when most people survive to these late ages. Increasing longevity raises the issue of net gain in active functional years versus total years of disability and dysfunction. The available evidence gives rise to pessimism: at present for each active functional year gained we add about 3.5 compromised years. The need for long-term care will continue to grow. Improvements in long-term care involve economic considerations, political will and better mechanisms for the delivery and acceptance of this labour-intensive practice. The education and preparation of the ageing population in terms of normal realities and expectations are even more important. Health-care givers, politicians, and other decision makers are increasingly likely to have first-hand exposure to the good and bad realities of an ageing society, and thereby to perceive the realities of ageing more clearly than ever before. A new political will for more creative and equitable responses to the needs of the elderly and their families is rapidly emerging. The greater our familiarity with the problems of old age, the greater the likelihood for us to find means for improvement.