How should we improve health care for older people? The British Geriatric Society’s (BGS) recent report Overcoming barriers to age-attuned care,1 documented a roundtable event, and there were some obvious areas to consider: the development of neighbourhood health care; the risks of digital exclusion; and the enormous potential for prevention in older people.
An evidence gap remains when it comes to older people. Participants in randomised controlled trials (RCTs) often bear little resemblance to the person in front of us in the clinic with their multimorbidity, polypharmacy, frailty, and cognitive decline.2 RCTs are always challenging to execute and people with additional needs get dropped for many reasons. We are too often groping around in the dark when it comes to treatments for older people and the extrapolation of results from younger adults is thin medicine.
Paediatricians tell us that children are not small versions of adults and we may be making a similar error with older people, particularly the very frail. Yet, it is complex, as one is often struck, meeting nonagenarians, how often they have few or no medications and little contact with medical services. One might assume they wouldn’t be chasing down their centuries, often with impressive joie de vivre, if it was otherwise.
The BGS roundtable participants felt ‘that the advanced care planning process should be digitally enabled with plans easily accessible by healthcare professionals across settings‘’. In this issue, Bushell et al found there was an important opportunity to introduce advance care planning earlier to patients with long-term conditions, and to normalise these conversations within wider society.3
Continuity of care was mentioned in the BGS report, but only once and in a single sentence. Many GPs may feel this is undervaluing this essential commodity. Leniz et al found that improved continuity is associated with lower costs for end-of-life care in people with dementia.4 Policymakers take note and add it to the list. But, it is hard not to pause and reflect on the human element of this finding – admitting someone to hospital at end-of-life will strike many as a dismal outcome. Health economics aside, if continuity can prevent these last resort admissions it should be embraced.
The BGS roundtable had all the right stakeholders and the document sets out the level of challenge. There was an elephant in the room and, to their credit, they call it out – there remains an abject failure to address the social care needs of older people in our society. The direct effects on the NHS are perhaps more visible for secondary care but it has slowly and steadily suffocated primary care and is an epic policy failure across successive governments.
Highlights
Research this month on older people covers the role of faecal calprotectin; patterns and patient factors in out-of-hours care; advanced care planning; continuity and costs; dementia risk prediction in areas of socioeconomic deprivation; and end-of-life injectable medication safety incidents. There is also research on the clinical assessment of recurrent cancer, and analysis of FIT screening highlights inequalities. We have editorials on winter pressures, hope and heart sink patients, and fit notes. Clinical Practice leans towards the dermatological with articles on chronic pruritus and obesity-related skin conditions. Analysis covers unexplained cancer symptoms and, as ever, Life & Times adds the all-important humanity and humanities.
Notes
- © British Journal of General Practice 2026
