People should adopt "old-fashioned" methods to stay healthy as they get older because falling sick is not inevitable, England's most senior doctor has said.
Professor Sir Chris Whitty also warned that some rural and coastal areas of the country were facing a disproportionate increase in older people that healthcare services needed to address.
People are living longer and, by 2050, a quarter of those in the UK will be over 65, but Sir Chris argued it should not be accepted that these extra years will be spent in ill health.
Research shows that people become less active as they get older, with a third of 75 to 85-year-olds and 57% of people aged 85 and over being physically inactive.
Publishing his annual report, Health in an Ageing Society, Sir Chris called on people to take responsibility for their own health with good diet and exercise, while calling on the Government to do more to make healthy lives the norm. He said that smoking rates are dropping, and alcohol intake is falling in some groups, but "obesity is going in the wrong direction".
"Old Fashioned" Ways of Staying Healthy
He suggested people should turn to methods that are known to work, saying: "There are a lot of things people can do themselves which will delay the point where they first have disability and then multi-morbidity. They are old-fashioned things, actually. Having lots of exercise, having mental stimulation and a social network, eating a reasonably balanced diet [with] not too much high fat, sugar, and salt, moderating alcohol, stopping smoking if you do – these are things which are old fashioned, but they still work."
He said maintaining exercise for the longest possible time, for example, was known to have a "huge positive impact on both physical and mental health in old age", while eating plenty of fruit and veg cuts the risk of high blood pressure, chronic heart disease and stroke.
His report further pointed to strong evidence "that being physically active, eating a healthy, balanced diet, not smoking and moderating alcohol consumption improves health outcomes and increases the proportion of life spent in good health".
The report said it is "possible to compress the period of ill health" people suffer by delaying the point at which they fall ill – and in some cases so they never get a disease before dying.
Elsewhere in the report, Sir Chris said older people suffer when homes, public buildings and towns are poorly planned. He said that "being an older person in many parts of the country is extremely difficult", with houses currently "built for young families" rather than older people.
Sir Chris suggested art galleries and libraries could have grab rails or ramps to help people move around, while pavements and cycle lanes should be accessible with even surfaces "because the key thing people want is independence".
Environmental factors that can negatively impact on health also include poor or cold housing and air pollution, he added.
Health Services Must Adapt to Shifting Populations
The report also examined the areas where people live, showing that the "great majority" of people move out of cities and large towns before old age, shifting to coastal and semi-rural areas "often with relatively sparse services and transport links". As a result, "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".
Providing services suitable for older people in these areas, including NHS care and social services, should therefore be "an absolute priority", the report said.
It added: "Homes for older people need to be located in places where they can easily and safely reach the everyday shops and services that they need, preferably by active transport (walking or cycling) to help maintain their physical health.
"Public and green spaces should be designed to meet the needs of older people, including those with sensory and physical impairments."
Healthcare in Later Life
In his report, Sir Chris also called for more joined-up thinking in the health service when people have more than one illness, and advance discussions about what should happen as people near the end of life.
He suggested too many people are given no choice when it comes to life-extending treatments when actually they may not feel it is in their best interests.
Sir Chris said that "extending life may or may not be right thing, and the key question on that should be 'what does the patient want?' And that question should be asked.
"Many people, for example, get rushed to hospital in the middle of the night simply because nobody knows what their wishes are."
Examples of such treatment might be major operations, chemotherapy, or continuing drugs which have side-effects and whose principal aim is to extend life, or repeated admissions to hospital.
"In medicine it is often easier to do more things, even when it is far from clear that quality of life will increase as a result," the report said.
"Over-treatment is as inappropriate as under-treatment in all patients, including older patients."
Paul Farmer, chief executive of Age UK, called for politicians and policy makers "to get a grip", adding: "Older people are isolated at home if the design of our communities mean they can't safely go out. People end up falling and in the back of an ambulance if our built environment is full of trip hazards.
"Our hospitals are over capacity at least in part, due to the failure to provide adequate social care and community services to enable people to stay safe and well at home. None of this is inevitable."