There has been an extraordinary increase in life
expectancies in developed countries. This trend, instead of being hailed
as a great achievement, is often seen as ‘a problem’. The reason for this
is that it is expected that the increasing number of old and very old
people will bring with it an increased burden of illness, particularly
chronic disabling diseases. There is, after all, an exponential relationship
between the prevalence of disabling conditions such as stroke,
dementia and osteoarthritis, and age. In fact, recent trends are rather
encouraging: despite recent dramatic increases in the life expectancy of
people who reach old age, there have not been significant increases in
the prevalence of disability among the old. This is because the biology of
ageing suggests that the longer chronic illness is postponed, the shorter
its duration before death. As Grimley Evans has put it, we “spend a
longer time living and a shorter time dying”. The challenge therefore is
to prevent the onset of disabling conditions or mitigate their impact. We
have made good progress in the case of stroke but there is much more to
be done by way of health promotion, disease prevention, improving the
way we use medication in older people, and in developing new methods
of reversing disability. In the case of neurodisability, recent advances
in neuroscience offer great promise of new approaches, exploiting the
plasticity of the brain. A future in which people enjoy a long life, with
a largely healthy old age—so that the health span approximates ever
more closely the life span—lies within our grasp.

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