1. Flu Epidemiological Clinical Ethical Philosophical …and older people

2. Medical Gerontology The interface between ageing and disease Organ or system specific disorders of high prevalence Special clinical problems e.g. falls, cognitive impairment, iatrogenic disease Population and epidemiological studies Service evaluation and HTA Study of human ageing (in individuals and populations) as it applies to the science and practice of medicine and therapeutics “Older people”

3. General Register Office for Scotland

4. Patterns for medical care Age distribution of emergency admissions Illness types –Heart disease –Infections, notably respiratory –Age related problems Dementia Poor mobility Incontinence Malignancies Need for care and support systems on discharge

5. Older people and clinical care Home –Other morbidities –Nonspecific presentation –Reduced support –Reduced threshold for admission

6. Older people and clinical care Hospital –No special considerations required? –Intercurrent illnesses –Frail, skin, nutrition –Assess on severity and likely complications –Tools for prioritisation, e.g. CURB-65 may be useful –Prolonged hospital stay

7. Older people and planning HCP: emphasis remains on the individual High level planning: emphasis shifts to include societal issues Utilitarian view seems reasonable –What if numbers exceed likely estimates? –Triage may exclude people >certain age, 85? –Who should decide criteria, and how?

8. Numbers… What if numbers exceed likely estimates? Triage may exclude people >certain age, 85? Who should decide criteria, and how?

9. Health Protection Scotland Framework for Response Age-specific impact Age specific impact is difficult to predict in advance. In the UK in 1918, a dramatic shift in age-specific impact (morbidity and mortality) occurred towards younger adults whereas the pandemics in 1957 and 1968 impacted across the age range of the population in a fashion much more akin to seasonal influenza (greatest impact in the elderly).

10. Years Excess mortality aged >65 Excess mortality aged <65 Risk ratio old:young At start of epidemic: relative risk for older group is low, but absolute risk is high Pandemic age-related mortality over time After Simonsen et al 1998

11. Determining morally relevant reasons for treating people differently “… care must be taken to ensure that any differences between individuals or groups that are used to justify different treatment are morally relevant differences. Thus, differences in race, sex or income are not seen as morally relevant. More controversial issues include whether factors such as personal responsibility for health and the presence of dependents are morally relevant in decisions about priority - setting in health care.

12. Section 3: Fairness Equal concern and respect is the fundamental principle that should inform our response. This means that: everyone matters everyone matters equally – but this does not mean that everyone is treated identically