At the start of 2004, I am pleased to have the opportunity of wishing all members of the British Geriatrics Society a happy and successful new year.

At the end of 2003 three announcements caught my attention. In the first, the Government Actuaries Department gave the latest population projections (www.gad.gov.uk) which show that the number of older people will increase further over the next decade. This comes as no surprise but will have implications for many aspects of life, including pensions, and of course health and social care. Members of our Society have been trying to draw attention to the demographic changes for at least the last quarter of a century, but few have paid attention until the recent scare over pensions. As well as the number of older people, two other factors will determine the need for care. The first is the state of health of older people in years to come. Many variables need to be thrown into the melting pot. If age-related disease and disability occur at the same rate as at present, we can predict an increase in demand for our services. On the other hand, if increased survival is accompanied by a decline or postponement of disease and disability, the pattern will be different. Secular changes in disease and disability cannot be analysed in routinely gathered data but research suggests that the onset of serious disability has been postponed in the last decade. This trend may be influenced by unforeseen factors, the “epidemic” nature of obesity in tomorrow’s older population, for example.

Informal Care
The other important factor is informal care. The Royal Commission on Long Term Care estimated that if informal care was not available, the additional annual cost of statutory care would be around £33 billion. There are considerable societal and cultural pressures on informal care. However these pressures have been in existence for several decades but informal care does not appear to be weakening and it seems that family bonds remain strong. Whatever the outcome of these predictions, the role of specialists in the care of older people will become ever more important.

Staying warm
An announcement from the Faculty of Public Health (www.fphm.org.uk) coinciding with a cold snap in December predicted the excess mortality of older people which would result from the cold weather. Hypothermia is a well know but relatively rare condition, but much more common is excess mortality in relation to cold weather, mainly from cardiovascular disease. The excess winter mortality which occurs in this country does not occur in colder parts of the world, such as Russia, Scandinavia and Canada. The suggested explanation is that in countries with very cold winters, preparations are made for colder weather whereas in this country, where the average weather conditions are milder and cold weather is less predictable, houses are not so well insulated or heated, and people do not take appropriate action to remain warm. Some years ago my colleagues and I undertook some research on the effects of season on cardiovascular risk factors. In the course of this we placed maximum/minimum thermometers in the bedrooms of the people aged 75 and over whom we were studying. It was striking how cold the bedrooms became during the night in the winter months, often approaching or reaching freezing. Equally striking was the fact that this not only occurred in bedrooms in individual houses, but also in sheltered accommodation and residential or nursing homes. Simple measures might well have great benefits on older people’s health. Perhaps the British Geriatrics Society should become involved in health promotion and health education through the public media.

Promoting clinical research
The third publication was a document from the Academy of Medical Sciences (www.acmedsci.ac.uk) on strengthening clinical research. This was shortly followed by a report from the Bioscience Industry and an announcement from the Government of a new committee to promote clinical research.

The background is that there have been huge advances in basic science in relation to medicine in the past few decades, but there is a deficit in our ability to apply these to the benefit of our patients because of a decline in clinical science, defined as experimental medicine and clinical trials. The Departments of Health, the Research Councils and the major charities will all be making major efforts to promote clinical research in the future. This presents an opportunity for us.

Many aspects of clinical practice which we believe benefit older people have not been subjected to proper evaluation. It is worth reflecting on the impact that the trials on stroke units have had on policy. Similar studies on other systems of care would be of equal benefit. This is another area in which our Society might be able to take a lead, for example in co-ordinating multi-centre trials.

Bob Stout