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Although Robine et al raise serious points about future trends in ageing, dependency, and care provision in later life,1 it is also worth noting that older people are also creative in their stratagems for later life and are not just passive recipients of care. Of particular importance is the contribution that they themselves bring to their own care. A longitudinal study of ageing in Ireland found a marked increase in the amount that older people spend on provision of health and social care2 over a four year sampling period, despite increases in access to services such as free general practitioner care. Over 8% of older people in this study were themselves the primary carer for another family member.
Therefore, even in advanced old age, a sense of partnership between services and all older people needs to be developed. Enabling this partnership, and responding to the changing demands of health and social care services, will require increased emphasis on effective care for older people, whether through acute geriatric medicine (which can reduce death and disability by 25%)3 or by improved chronic disease management.4 It will also require some thought to ensuring that the societal structures, such as housing and transport,5 do not hinder participation of the oldest old in sharing in their own care.
Competing interests: None declared.