The 20th century has seen a huge change in both longevity as well as social attitudes to ageing. The increase in life expectancy has been due to dramatic improvements in public health, and the application of medical science. The rate of knowledge increase in molecular biology and genetics, in particular, has meant that it is extremely difficult to predict the impact of this on `healthy ageing'. While cardiovascular disease remains the main cause of mortality and morbidity1, current treatment options are likely to change dramatically, even within the foreseeable future.

There is much concern that we will survive longer, only to be disabled and therefore dependent on the rest of society. We therefore face very complex questions about how evolving medical advances as well as social changes will impact on the ever-increasing proportion of elderly people. Australia has been a world leader in developing effective and efficient community-based support and rehabilitation for the disabled elderly. However the costs of social support and residential care continue to spiral.

What then will be the role of the doctor and prescriber in this ageing society in the future? While advances will reduce the proportion of disability due to disease, it is likely that there will be a significant (and probably increasing) group of vulnerable elderly people who are dependent, especially on their doctors. These people may not be `curable', but their lives will be enriched immensely by an empathetic relationship with their doctor which allows them to maintain their autonomy and dignity, have access to wisely applied scientific advances and retain their position as valued members of society.


S. Kanagarajah

Head, Geriatric Medicine, Illawarra Area Health Service, Warrawong, N.S.W