Prevention in Older Age

The focus of prevention in older age groups is around healthy active ageing and supporting independence so older people area able to enjoy long and healthy lives, feeling safe at home and connected to their community.

Healthy ageing is associated with being physically active, not smoking, eating healthily, maintaining a healthy weight and drinking alcohol sensibly. Therefore, changing these common behavioural risk factors during adult life, not only reduces the risk of non-communicable disease (such as heart disease or stroke), but also helps prevent dementia, disability and frailty.

In January 2014, NHS England published Safe, compassionate care for frail older people using an integrated care pathway:

Their pathway contains nine stages, each containing evidence-based examples taken from the Silver Book:, and the King’s Fund’s Making our health and care systems fit for an ageing population  The nine stages are:

  1. Healthy active ageing and supporting independence
  2. Living well with simple or stable long-term conditions
  3. Living well with complex comorbidities, dementia and frailty
  4. Rapid support close to home in a crisis
  5. Good acute hospital care when (and only when) needed
  6. Good discharge planning and post-discharge support
  7. Good rehabilitation and re-ablement after acute illness or injury
  8. High quality nursing and residential care for those who truly need it
  9. Choice, control and support towards the end-of-life

Further to this, the National Institute for Clinical Excellence (NICE) have recently published draft guidance on mid-life approaches to the prevention of dementia, disability and frailty entitled ‘Disability, dementia and frailty in later life – mid-life approaches to prevention’:

This guidance emphasises changes to these behavioural risk factors during adult life will reduce the risk of dementia, disability and frailty in later life. The NHS Health Check programme provides one mechanism to do this. Individual behaviour change approaches such as this are likely to be more cost effective and less likely to widen health inequalities when combined with population-based approaches.

Box 6, Non-Urgent Care, Perceptions and Experiences


In 2014 Healthwatch Devon ran a survey on non-urgent care which received over 500 responses.  The survey was focused on access to primary care services, in response to national findings from Healthwatch England highlighting that some people were resorting to using urgent care services, such as accident and emergency departments due to difficulties in accessing primary care.

The majority of respondents found it easy to make an appointment with their GP.

“I feel my GP surgery is very good. I am always able to get an appointment if I need one, on the same day. The staff are friendly and helpful and the surgery is located in the same building as a pharmacy, which is very useful”

Around a quarter had some difficulty.

“Trying to get an appointment to see someone is like getting blood from a stone…when you ring at 8.30am everyone else is ringing at the same time”

Concerns and issues highlighted included:

  • Rigid appointment booking systems
  • Not being able to get through to make an appointment on the telephone
  • Not being able to see the GP of choice on the day
  • Long waiting times to see a named GP
  • Staff attitude and communication, particularly within reception
  • If people are not able to make an appointment with their GP, the majority of those surveyed would visit their local pharmacy, slightly more than a fifth would call 111 and a further fifth would ‘do nothing’
  • A quarter of those surveyed were unsure about the range of services available to them if they required non urgent medical treatment or advice
  • Walk-In Centres were praised by many people as being a useful resource, with several suggesting that there should be more places where people can walk in and be seen by a medical professional without the need to book an appointment
  • Responses suggest that more information needs to be made available to the public to explain the 111 Service
  • Many people were unsure what ‘non-urgent’ means and those surveyed suggested that people need more information and advice to help people understand when it is necessary to go to A&E, or when another service would be more appropriate.


Healthwatch Devon, ‘Speaking out on non-urgent care’ Report, August 2014