A SURGE in elderly Scots living with more than four long-term conditions threatens to cripple the NHS over the next two decades, it has been claimed.

But health experts say it is not too late to turn the tide on the crisis if unhealthy habits can be curbed now.

It follows the launch of The Herald’s Grey Matters project, a major new series exploring the consequences, good and bad, of Scotland’s fast ageing population.

Research presented in Edinburgh in January this year laid bare the scale of the disease burden the ageing population is likely to pile on the country’s health service.

The provisional findings, which have not previously been published, forecast that between 2015 and 2025 there will be an increase of around 43 per cent in diabetes, 32 per cent in hypertension (high blood pressure), and a more than 47 per cent increase in arthritis.

This is largely due to the explosion in the very elderly population, with the number of people aged over 85 set to increase 110 per cent by 2034 in comparison to an overall increase among the over-65s of just 49 per cent.

This is of huge significance to the NHS because this cohort is not only going to swell in number, but the generation coming through is also expected to be unhealthier than its current counterparts.

By 2040, more than half of over 85s will be living with more than four morbidities – such as dementia, cardiovascular disease, diabetes, arthritis and hypertension – at once.

For example, whereas 14 per cent of over-85s have diabetes now, provisional findings suggest this will grow to about 30 per cent by 2040.

Professor Carol Jagger, AXA Professor of Epidemiology of Ageing at Newcastle University’s Institute for Ageing, has spearheaded the research.

She said: “You have higher mortality rates in some areas so that will mean shorter lives in total, but you do have very high rates of some of the risk factors and huge inequalities.

“Our health service was designed when there were few very old people, so we didn’t really have a picture of what the health of very old people was like. It’s only relatively recently that we have had sufficient data to do that.

“Our early results from our models suggest it’s going to get worse rather than better. Part of the increase up to now potentially is that we diagnose more now than we did, but I would say from now on in that’s not really [going to be] the case.”

The results, though based on modelling using English population trends, are not expected to differ significantly in Scotland.

The problem of multiple conditions has far-reaching effects on the health service, from a spiralling drugs bill – already the second highest cost after staff – to pressure on hospital beds. 

Unplanned hospital admissions for older people cost the NHS and councils around £1.4 billion a year – more than home care, care homes and most of GP prescribing combined. One of the biggest drivers behind unplanned hospital admissions is side effects from medicines.  The more conditions a patient has, the more prescription medications they take and the higher the risk of side effects from not taking them as advised or from drugs interaction.

Already, 61,000 unplanned admissions to hospital each year in Scotland are caused by medicines, at an average cost of £2,746 per stay.

Without action, the health service will be saddled with an impossible conundrum of ever-increasing numbers of elderly people with long-term conditions requiring emergency admissions at a time when the trend favours cutting costs through a reduction in hospital beds. 

The situation has led to calls from the Royal Pharmaceutical Society Scotland to give pharmacists, rather than GPs, a greater role in reviewing patients’ overall prescriptions.

Ms Jagger stressed the toll of elderly people with multiple conditions should also force a reshape in the health service away from single disease clinics to an all-in-one geriatric service, otherwise the elderly “could spend all week attending clinics”. 

However, she added that there was still time to limit the toll of multi-morbidity if people currently under-60 changed their lifestyles.

“Most of these conditions are driven by unhealthy behaviours so reducing obesity, cutting out smoking, reducing alcohol and increasing physical activity will delay the onset of conditions,” said Ms Jagger. 

“A number of conditions often share the same risk factors. So obesity is a risk factor for arthritis, dementia, coronary heart disease, cancer, and so you have the potential to reduce or delay a number of them with healthy behaviours.”

Prevention is also key for Dr Elaine Douglas, who is helping to steer Scotland’s first  longitudinal study on healthy ageing at Stirling University. The Healthy Ageing in Scotland (HAGIS) study is part of a worldwide network of long-term research comparing lifestyles, genes, and environmental factors to health outcomes, with sister projects in countries including England, the USA and Japan.

Currently, a boy born in Scotland in 2009 can expect to live to 76, but has a healthy life expectancy of just 60. For girls, life expectancy is 80 but they will typically be living with at least one disability or chronic condition from the age of 62.  That has implications not only for the NHS, but for the economy as a whole at a time when changing demographics will require people to work longer before retirement.

Dr Douglas said: “If we can help people to live healthier lives for longer then that’s great for individuals because they are less of a burden on the health service, but also they will probably work for longer as well.
“We know that keeping working can keep you healthier, for example by helping to maintain social networks and reducing loneliness which we know is associated with poorer health outcomes.

“But I don’t think I want to be working at the same rate when I’m in my 60s or nearer 70 as I do now. 

“I may still want to be working, but I think as a nation we need to look at how we can support people so that instead of people retiring because they don’t feel they can cope with the demands of a full-time position. 
“We need to look at ways where we can keep people working for longer – perhaps through more flexible working or part-time
working, which feeds into taxes to pay for healthcare but also keeps people healthier for longer.”