Supporting healthy ageing

Organisations across the sector responded to the Chief Medical Officer’s 2023 report, Health in an ageing society, raising topics of domiciliary support, the need for a National Eye Health Strategy and the effects of sensory impairment

Two older individuals are standing in a forest, holding hands and looking to each other. Beyond them, through the trees, is a hilly landscape.
Pexels/Magda Ehlers
England’s Chief Medical Officer Professor Chris Whitty has highlighted opportunities to improve the quality of life of older citizens in his annual report.

The 2023 report Health in an ageing society, notes a rise in multimorbidity, requiring changes in medical training, NHS services and research.

Whitty acknowledges that sensory impairment, such as sight or hearing loss, is a major contributor to disability in older age, suggesting that early identification can enable early treatment and prevent negative effects on quality of life.

The report also recognises the geography of older demographics, which skew towards more rural and coastal areas, with Whitty writing: “For policymakers, the biggest concern I have is that government and professional bodies have not recognised the degree to which the population living in older age is concentrating geographically in the United Kingdom in general, and England specifically."

“Manchester, Birmingham and London will age very slowly, but areas such as Scarborough, North Norfolk or the south coast are going to age rapidly and predictably,” he said, adding that providing services and environments suitable for this demographic, in these areas, “is an absolute priority if we wish to maximise the period all older citizens have in independence.”

OT gathered viewpoints from organisations across the profession, and organisations seeking to improve the quality of life of older people.

Equal access to eye care

Nick Wingate, director of professional services at OutsideClinic, said: “We wholeheartedly align with the message conveyed in the report, which emphasises the imperative need to enhance the quality of life for individuals as they age.”

As a provider of domiciliary eye care for more than 36 years, OutsideClinic “take immense pride” in providing at-home services to individuals unable to attend appointments on the High Street, Wingate shared, “But we also acknowledge that our visits extend beyond the realm of eye care; they also serve as a break in loneliness – something that often plagues older individuals, especially those who are housebound.”
middle aged man smiling with dark grey hair. He is wearing an off-white shirt and glasses
Nick Wingate
Asked about the issues of the geographical concentration of need identified in the report, Wingate told OT: “An ageing population, as highlighted in the report, may be more rural and demonstrates the importance of recruiting optometrists in all areas.”

Through strategic expansion, and with a newly appointed national team of optometrists, he suggested OutsideClinic has been able to bridge geographical gaps, “ensuring that our service extends to those residing in remote areas.”

Outlining issues that still require attention, Wingate shared: “Optometrists bring valuable skills and training that align seamlessly with the NHS mission of delivering healthcare in the comfort of patients’ homes. However, a significant challenge lies in ensuring adequate representation of the domiciliary sector to support primary prevention – a concern addressed by more innovative eye care contracts.”

One key issue is the pre-visit notification requirement in England, which Wingate noted is not a condition in Scotland or Wales.

“This discrepancy leads to unequal access to eye care for older individuals who cannot access traditional High Street eye care services and will need to wait at least 48 hours for an eye test,” he said. “We believe that addressing this issue in England is essential to ensure equal access to eye care services.”

With an ageing population, the need for domiciliary services is increasing

Nick Wingate, director of professional services at OutsideClinic

Wingate also recommended a greater acknowledgement of domiciliary eye care as a career choice from an earlier age.

“With an ageing population, the need for domiciliary services is increasing,” he said. “We believe more efforts should be made to nurture a new generation of professional who are passionate about ensuring equal access to eye care for everyone, regardless of their age, mobility, or circumstances.”

OutsideClinic is promoting the domiciliary sector in universities through its interactive University Project, but Wingate said, “we believe there is more than can be done in this regard.”

“The report argues that older people are currently underserved in healthcare, with less accessible transport links and we strongly believe that domiciliary services should receive top priority in all aspects of healthcare.”

Wingate highlighted that domiciliary services are essential to ensure comprehensive healthcare reaches those who face access issues.

“It’s important to remember that eye health is just one piece of the healthcare puzzle. These interconnected health issues show why we must not discriminate against older individuals or those who care for them and ensure that everyone has equal access to healthcare despite their circumstances.”

The call for a National Eye Heath Strategy

Acknowledging the “profound effect” that sight loss or impairment can have on quality of life in older age, Whitty noted in his report that visual impairment can interact negatively with other sensory loss such as hearing or balance.
Woman smiling with short brown curly hair. She is wearing a black shirt and glasses
Joanna Hodginson
“Many of the causes of sight loss can be slowed, prevented, reduced or in some cases reversed. These include refractive errors (short and long sightedness), cataracts, glaucoma, macular degeneration and diabetic eye disease,” Whitty wrote.

Joanna Hodgkinson, head of support services at Glaucoma UK, told OT: “We are grateful that improving older people’s quality of life is recognised as a major priority.”

Age is one of the biggest risk factors for glaucoma, the organisation shared, and while around 2% of the population over the age of 40 has been diagnosed with glaucoma, this increases to one in 10 people aged 75 or over.

The most effective way for the Government to eliminate preventable glaucoma sight loss is to develop a national eye care strategy

Joanna Hodgkinson, head of support services at Glaucoma UK

“However, glaucoma does not affect people equitably: black people and those in socio-economically deprived communities are more likely to experience glaucoma sight loss – which is irreversible but also often preventable,” Hodgkinson said. “We want to ensure that people diagnosed with glaucoma retain useful sight for life, enabling them to live independently, and well, and successfully manage other conditions associated with ageing.”

Glaucoma UK welcomed the report’s focus on challenges associated with multimorbidity and the importance of effective liaison between health and social care.

“The most effective way for the Government to eliminate preventable glaucoma sight loss is to develop a national eye care strategy,” Hodgkinson said. “We need a combined approach that takes into account these challenges and can help address systemic issues such as poor IT connectivity between primary and secondary eye care, and a fragmented health care system.”

Under-appreciated effects of hearing loss

Commenting on the report, Giles Edmonds, Specsavers clinical services director, said: “In community optometry and audiology, we have the skills and expertise to support the NHS in helping the country adapt to the ageing population from community practices to the home visits service.”

Whitty noted the effect of hearing loss on factors such as social interaction, calling it “under-appreciated” and highlighting that several causes of hearing loss can be slowed and the effects reversed through technology.

In community optometry and audiology, we have the skills and expertise to support the NHS in helping the country adapt to the ageing population

Giles Edmonds, Specsavers clinical services director

In its Access to Care report, Specsavers suggested that patient self-referral to audiology practices would save around 500,000 GP appointments per year, but that only 16 out of 42 integrated care boards in England commission community audiology for their whole footprint, and that there are none commissioned in other nations.

Edmonds commented: “That is why we are calling for the introduction of a nationally commissioned primary care audiology service in all communities, and for all age adults, as NHS Wales and NHS Scotland have committed to.”